Please note:

Any dietary or drug treatment with high doses of micronutrients may override the body's own control mechanisms; therefore, micronutrient therapies may be associated with potential side effects and toxicities. High-dosed micronutrients should not be used without medical supervision..

 

High cholesterol and cardiovascular disease

The Coronary Drug Project (CDP) followed over 8,000 men with a history of heart attack (‘myocardial infarction’) for six years (13). Compared to the placebo group, the group that took 3 g vitamin B3 (nicotinic acid) daily experienced an average 10% reduction in total blood cholesterol, a 26% decrease in triglycerides, a 27% reduction in recurrent non-fatal myocardial infarction, and a 26% reduction in stroke (‘cerebrovascular’ events). A post-trial follow up nine years later revealed a 10% reduction in total deaths with nicotinic acid treatment.

 

Four out of five major cardiovascular outcome trials found vitamin B3 (nicotinic acid) in combination with other therapies to be of statistically significant benefit in men and women (14).

 

Because of the heart-protective effects of high doses of vitamin B3 (nicotinic acid), potentially related to changes in blood lipid profile (e.g., increase of HDL-cholesterol levels and decrease of LDL), it has been used in combination with other lipid-lowering medications: a randomized controlled trial found that a combination of nicotinic acid (2–3 g/day) and a cholesterol-lowering drug (simvastatin) resulted in greater benefits on serum HDL levels and cardiovascular events, such as heart attack and stroke, than placebo in patients with coronary artery disease and low HDL levels (15). The effects of niacin were dose-dependent (16, 17).

 

Although it is a nutrient, at doses required for cholesterol-lowering effects, the use of vitamin B3 (nicotinic acid) should be approached as if it were a drug. Individuals should only undertake cholesterol-lowering therapy with nicotinic acid under the supervision of a qualified health care provider in order to minimize potentially adverse effects and maximize therapeutic benefits.

 

HIV / AIDS

It has been hypothesized that infection with human immunodeficiency virus (HIV), the virus that causes acquired immmunodeficiency syndrome (AIDS), increases the risk of vitamin B3 (niacin) deficiency (18). An observational study in 281 HIV-positive men found that higher levels of niacin intake were associated with decreased progression rate to AIDS and improved survival (19).

 

More research is needed to determine whether there is any real benefit.

 

Osteoarthritis

One preliminary study suggested that nicotinamide may improve arthritis symptoms, including increasing joint mobility and reducing the amount of nonsteroidal anti-inflammatory drugs (NSAIDs) needed (20).