Rankings / Cardiovascular & Lipids
Niacin (nicotinic acid)
CV/Lipid · B3 / lipid modifier
Tier B-
What this is
Niacin's Lp(a) niche is now being eclipsed by Lp(a)-targeted siRNA/ASO/oral agents (olpasiran, pelacarsen, lepodisiran, zerlasiran, muvalaplin) which lower Lp(a) 54-92% in trials. 'Flush-free' inositol hexanicotinate does not have the lipid-modifying effect of true niacin. HPS2-THRIVE 2014 largely ended routine use for CV outcomes.
Mechanism
Inhibits hepatic DGAT2 (VLDL assembly); raises HDL, lowers LDL, triglycerides, Lp(a) — the latter was one of the few tools available pre-2025; not to be confused with nicotinamide (which lacks lipid effects)
Dose & route
1.5-3 g/day PO divided with food; start low and titrate; aspirin 30 min prior reduces flushing
Citations
- https://pubmed.ncbi.nlm.nih.gov/24552284/
- https://pubmed.ncbi.nlm.nih.gov/22085343/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4135400/
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This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.