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B36.0
Niacin Research
Probably helps
283 peer-reviewed studies
What the evidence says
Probably helps
Niacin helped in about half (8/15) of the studies that measured an effect — promising, but not unanimous.
Most evidence is from high-quality meta-analyses and randomised trials published 1983–2026 with a typical study size of 1,848 participants.
Based on 283 studies · 42 meta-analyses · 218 RCTs · 628,512 total participants
Confidence
High confidence
What the studies found
8helped5unclear2didn't help· 268 more without graded effect data
By outcome
Cholesterol & lipidsRaises HDL and modifies lipid profiles at pharmacological doses · 4-8 weeks
Probably helps252 studies
Niacin flush & tolerability
Limited support95 studies
Glucose & metabolic
Mostly mechanism / observational26 studies
Heart & blood pressureRaises HDL and modifies lipid profiles at pharmacological doses · 4-8 weeks
Probably helps19 studies
Skin health
Probably helps14 studies
Therapeutic & clinical
Mostly mechanism / observational13 studies
Safety profile
Mostly mechanism / observational12 studies
Longevity & agingIncreased NAD+ levels for cellular health · Ongoing
Mostly mechanism / observational8 studies
Energy & fatigue
Too few graded studies2 studies
Pellagra & niacin deficiency
Too few graded studies1 study
Neuroprotection & brain aging
Too few graded studies1 study
By the numbers
Pulled from 43 studies with measurable effects
Likely real effects
82%
across studies
People studied
629k
typical study: 1848 people
Strongest designs
260
42 pooled, 218 randomised
Showed benefit
53%
8/15 studies
How long studies ran
Under a week
1
1–3 months
2
3+ months
2
Populations Studied
Healthy adults3
Cardiovascular disease prevention2
General population2
Patients on lipid-lowering therapies1
Steady research
43 studies in the last 5 years · Latest meta-analysis: 2026
198320042026
1Lipoprotein(a) levels reductionMeta-AnalysisCited 13×n=145,314 · very large study2025
Among available LLTs, PCSK9mAbs, inclisiran, CETPi, and niacin significantly decreased Lp(a) levels.
Xie S et al. · Atherosclerosis (2025)
Among available LLTs, PCSK9mAbs, inclisiran, CETPi, and niacin significantly decreased Lp(a) levels.
Further research is necessary to understand whether this effect would translate into a clinically relevant cardiovascular benefit.
2Fasting blood glucose reductionMeta-AnalysisCited 31×n=14,223 · very large study2023
Low to very low certainty evidence established chromium supplements as the most effective in reducing fasting blood glucose levels and homeostasis model assessment of insulin resistance (SUCRAs: 90...
Xia J et al. · Pharmacological research (2023)
Low to very low certainty evidence established chromium supplements as the most effective in reducing fasting blood glucose levels and homeostasis model assessment of insulin resistance (SUCRAs: 90.4% and 78.3%, respectively).
Vitamin K supplements ranked best in reducing glycated hemoglobin A1c and fasting insulin levels (SUCRAs: 97.0% and 82.3%, respectively), with moderate to very low certainty evidence.
Vanadium supplements ranked best in lowering total cholesterol levels with very low evidence certainty (SUCRAs:100%).
4Treatment discontinuation due to side effectsMeta-AnalysisCited 88×n=39,195 · very large study2017
Moderate- to high-quality evidence suggests that niacin does not reduce mortality, cardiovascular mortality, non-cardiovascular mortality, the number of fatal or non-fatal myocardial infarctions, nor the number of fatal or non-fatal strokes but is associated with side effects.
Schandelmaier S et al. · The Cochrane database of systematic reviews (2017)
Huge harm
← WorseNo effectBetter →
Participants randomised to niacin were more likely to discontinue treatment due to side effects than participants randomised to control group (RR 2.17, 95% CI 1.70 to 2.77; participants = 33,539; studies = 17; I2 = 77%; moderate-quality evidence).
Moderate- to high-quality evidence suggests that niacin does not reduce mortality, cardiovascular mortality, non-cardiovascular mortality, the number of fatal or non-fatal myocardial infarctions, nor the number of fatal or non-fatal strokes but is associated with side effects.
Benefits from niacin therapy in the prevention of cardiovascular disease events are unlikely.
6Meta-AnalysisCited 25×n=60,194 · very large study2019
High-certainty evidence supports statin use for secondary prevention in older individuals.
Ponce OJ et al. · The Journal of clinical endocrinology and metabolism (2019)
For primary prevention, statins reduced the risk of coronary artery disease [CAD; relative risk (RR): 0.79, 95% CI: 0.68 to 0.91] and myocardial infarction (MI; RR: 0.45, 95% CI: 0.31 to 0.66) but not all-cause or cardiovascular mortality or stroke.
For secondary prevention, statins reduced all-cause mortality (RR: 0.80, 95% CI: 0.73 to 0.89), cardiovascular mortality (RR: 0.68, 95% CI: 0.58 to 0.79), CAD (RR: 0.68, 95% CI: 0.61 to 0.77), MI (RR: 0.68, 95% CI: 0.59 to 0.79), and revascularization (RR: 0.68, 95% CI: 0.61 to 0.77).
High-certainty evidence supports statin use for secondary prevention in older individuals.
7Myocardial infarctionMeta-AnalysisCited 48×n=154,601 · very large study2019
The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality, stroke or all-cause mortality.
Riaz H et al. · European journal of preventive cardiology (2019)
Noticeable benefit
← WorseNo effectBetter →
Likely real
High-density lipoprotein cholesterol modifiers reduced the RR of myocardial infarction (RR 0.87, 95% CI 0.82-0.93, P < 0.001, I2 = 37%).
This significant effect was derived by the use of fibrates (RR 0.80, 95% CI 0.73-0.87, P < 0.001, I2 = 22%) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol.
High-density lipoprotein cholesterol modifiers had no effect on stroke (RR 1.00, 95% CI 0.93-1.09, P = 0.94, I2 = 25%) or all-cause mortality (RR 1.02, 95% CI 0.97-1.08, P = 0.48, I2 = 49%).
8Lipoprotein(a) levelsMeta-AnalysisCited 106×n=9,013 · very large study2016
In this meta-analysis of randomized placebo-controlled clinical trials, treatment with nicotinic acid was associated with a significant reduction in Lp(a) levels.
Sahebkar A et al. · Metabolism: clinical and experimental (2016)
Large benefit
← WorseNo effectBetter →
Likely real
Meta-analysis suggested a significant reduction of Lp(a) levels following ER niacin treatment (weighted mean difference - WMD: -22.90%, 95% CI: -27.32, -18.48, p<0.001).
Results also remained similar when the meta-analysis was repeated with standardized mean difference as summary statistic (WMD: -0.66, 95% CI: -0.82, -0.50, p<0.001).
When the studies were categorized according to the administered dose, there was a comparable effect between the subsets of studies with administered doses of <2000mg/day (WMD: -21.85%, 95% CI: -30.61, -13.10, p<0.001) and ≥2000mg/day (WMD: -23.21%, 95% CI: -28.41, -18.01, p<0.001).