B39.0

Niacin Research

43 peer-reviewed studies · Evidence score: 9/10

Effect of lipid-lowering therapies on lipoprotein(a) levels: a comprehensive meta-analysis of randomized controlled trials

Xie S et al. • Atherosclerosis (2025)

Among available LLTs, PCSK9mAbs, inclisiran, CETPi, and niacin significantly decreased Lp(a) levels.

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.
Further research warranted to confirm findings

Meta-Analysisn=145,314

DOI

Comparative effects of vitamin and mineral supplements in the management of type 2 diabetes in primary care: A systematic review and network meta-analysis of randomized controlled trials

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...

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%).

Meta-Analysisn=14,223

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Effect of maternal dietary niacin intake on congenital anomalies: a systematic review and meta-analysis

Palawaththa S et al. • European journal of nutrition (2022)

Inadequate maternal niacin intake is associated with an increased risk of congenital anomalies in the offspring.

The meta-analysis showed that expectant mothers with an insufficient niacin intake were significantly more likely to have babies with congenital abnormalities (odds ratio 1.13, 95% confidence interval 1.02-1.24) compared to mothers with adequate niacin intake.
A similar association between niacin deficiency and congenital anomalies was observed (OR 1.15, 95% CI 1.03-1.26) when sensitivity analysis was conducted by quality of the included studies.
Meta-regression showed neither statistically significant impact of study size (p = 0.859) nor time of niacin assessment (p = 0.127).

Meta-Analysisn=35,743

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The comparative impact among different intensive statins and combination therapies with niacin/ezetimibe on carotid intima-media thickness: a systematic review, traditional meta-analysis, and network meta-analysis of randomized controlled trials

Li H et al. • European journal of clinical pharmacology (2021)

Statins combined with niacin performed a greater CIMT reduction compared to high-intensity statins alone and combination therapies with ezetimibe.

Statins combined with niacin performed a greater CIMT reduction compared to high-intensity statins alone and combination therapies with ezetimibe.
The advantage of niacin-combined statins therapies to improve cardiovascular endpoint needs further validation through randomized controlled trials.
Further research warranted to confirm findings

Meta-Analysisn=8,762

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Niacin for primary and secondary prevention of cardiovascular events

Schandelmaier S et al. • The Cochrane database of systematic reviews (2017)

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.

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.

Meta-Analysisn=39,195

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Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes: A Systematic Review and Meta-analysis

D'Andrea E et al. • JAMA Network Open (2019)

Niacin monotherapy associated with reduced cardiovascular events in patients without statin treatment.

35,760 patients analyzed
No benefit when added to statins
Monotherapy may reduce events in statin-intolerant patients

Meta-Analysisn=35,760

DOI

Lipid-Lowering Agents in Older Individuals: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Ponce OJ et al. • The Journal of clinical endocrinology and metabolism (2019)

High-certainty evidence supports statin use for secondary prevention in older individuals.

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.

Meta-Analysisn=60,194

DOI

Effects of high-density lipoprotein targeting treatments on cardiovascular outcomes: A systematic review and meta-analysis

Riaz H et al. • European journal of preventive cardiology (2019)

The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality, stroke or all-cause mortality.

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%).

Meta-Analysisn=154,601

DOI

Effect of extended-release niacin on plasma lipoprotein(a) levels: A systematic review and meta-analysis of randomized placebo-controlled trials

Sahebkar A et al. • Metabolism: clinical and experimental (2016)

In this meta-analysis of randomized placebo-controlled clinical trials, treatment with nicotinic acid was associated with a significant reduction in Lp(a) levels.

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).

Meta-Analysisn=9,013

DOI

The current state of niacin in cardiovascular disease prevention

Lavigne PM et al. • Journal of the American College of Cardiology (2013)

Niacin reduces CVD events through mechanisms not reflected by HDL-C changes alone.

Systematic review and meta-regression
CVD reduction occurs independent of HDL increase
May benefit patients intolerant to statins

Meta-Analysisn=35,206

DOI

Nutritional Status of Children Diagnosed With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Alhrbi A et al. • Journal of human nutrition and dietetics : the official journal of the British Dietetic Association (2025)

Journal of Human Nutrition and Dietetics

We used standardized mean difference (SMD) as an effect size for continuous variables and risk ratio (RR) for dichotomous variables with a 95% confidence interval (CI).
Children with ASD were statistically significantly shorter than TDC (SMD: -0.16, 95% CI [-0.28, -0.04], I2 = 7%), but no difference in weight [-0.12, 95% CI (-0.17, 0.92)] and BMI [-0.06, 95% CI (-0.32, 0.20)].
Also, children with ASD had a statistically significantly decreased intake of some water-soluble vitamins like folate, riboflavin, thiamine and niacin.

Meta-Analysis

DOI

Neuronutrients and Central Nervous System: A Systematic Review

Nogueira-de-Almeida CA et al. • Central nervous system agents in medicinal chemistry (2023)

The areas of neurology and psychiatry have shown great advances regarding the deepening of knowledge in prophylaxis and pathophysiology, as well as in the treatment of established diseases.

According to the GRADE instrument, most studies (>50%) followed a controlled clinical study model and had a good methodological design.
The areas of neurology and psychiatry have shown great advances regarding the deepening of knowledge in prophylaxis and pathophysiology, as well as in the treatment of established diseases.
The recognition of the role of nutrition as an adjunct to these processes is currently growing.

Systematic Reviewn=118

DOI

A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk

Ferrell M et al. • Nature medicine (2024)

The Author(s), under exclusive licence to Springer Nature America, Inc.

Lastly, treatment with physiological levels of 4PY, but not its structural isomer 2PY, induced expression of VCAM-1 and leukocyte adherence to vascular endothelium in mice.
Collectively, these results indicate that the terminal breakdown products of excess niacin, 2PY and 4PY, are both associated with residual CVD risk.
They also suggest an inflammation-dependent mechanism underlying the clinical association between 4PY and MACE.

Meta-Analysis

DOI

Systematic Review and Meta-Analysis on the Association Between Daily Niacin Intake and Glaucoma

Nicola CA et al. • Nutrients (2024)

Daily dietary intake of niacin is significantly lower in patients with glaucoma compared to the general population.

Daily dietary intake of niacin is significantly lower in patients with glaucoma compared to the general population.
Given different average daily intakes of niacin in these populations, different glaucoma definitions and several confounding variables which weaken the associations, large sample, standardised randomised controlled trials are needed to confirm the potential benefits of niacin in glaucoma.
Further research warranted to confirm findings

Meta-Analysis

DOI

The Role of Nicotinamide as Chemo-Preventive Agent in NMSCs: A Systematic Review and Meta-Analysis

Tosti G et al. • Nutrients (2023)

The present meta-analysis shows, by pooling immunocompetent and immunosuppressed patients, that there is insufficient evidence that oral nicotinamide therapy significantly reduces the number of keratinocyte cancers.

There was no association between NAM consumption and risk for squamous cell carcinoma (SCC) (rate ratio (RR) 0.81, 95% CI 0.48-1.37; I2 = 0%), basal cell carcinoma (BCC) (RR 0.88, 95% CI 0.50-1.55; I2 = 63%), and NMSC (RR 0.82, 95% CI 0.61-1.12; I2 = 63%).
The present meta-analysis shows, by pooling immunocompetent and immunosuppressed patients, that there is insufficient evidence that oral nicotinamide therapy significantly reduces the number of keratinocyte cancers.
Further research warranted to confirm findings

Meta-Analysis

DOI

Association Between Lowering LDL-C and Cardiovascular Risk Reduction Among Different Therapeutic Interventions: A Systematic Review and Meta-analysis

Silverman MG et al. • JAMA (2016)

In this meta-regression analysis, the use of statin and nonstatin therapies that act via upregulation of LDL receptor expression to reduce LDL-C were associated with similar RRs of major vascular events per change in LDL-C.

A total of 312 175 participants (mean age, 62 years; 24% women; mean baseline LDL-C level of 3.16 mmol/L [122.3 mg/dL]) from 49 trials with 39 645 major vascular events were included.
For these 5 therapies combined, the RR was 0.77 (95% CI, 0.75-0.79, P < .001) for major vascular events per 1-mmol/L reduction in LDL-C level.
In this meta-regression analysis, the use of statin and nonstatin therapies that act via upregulation of LDL receptor expression to reduce LDL-C were associated with similar RRs of major vascular events per change in LDL-C.

Meta-Analysisn=175

DOI

The effect of niacin on inflammatory markers and adipokines: a systematic review and meta-analysis of interventional studies

Rad EY et al. • European journal of nutrition (2024)

Niacin treatment is associated with significant reductions in CRP and TNF-α levels, suggesting potential anti-inflammatory effects.

Niacin administration demonstrated a notable reduction in CRP levels (SMD: -0.88, 95% CI: -1.46 to -0.30, p = 0.003).
Niacin administration also substantially elevated Adiponectin (SMD: 3.52, 95% CI: 0.95 to 6.1, p = 0.007) and Leptin (SMD: 1.90, 95% CI: 0.03 to 3.77, p = 0.04) levels.
Niacin treatment is associated with significant reductions in CRP and TNF-α levels, suggesting potential anti-inflammatory effects.

Meta-Analysis

DOI

A systematic literature review and meta-analysis of the effect of psilocybin and methylenedioxymethamphetamine on mental, behavioural or developmental disorders

Kisely S et al. • The Australian and New Zealand journal of psychiatry (2023)

Methylenedioxymethamphetamine and psilocybin may show promise in highly selected populations when administered in closely supervised settings and with intensive support.

Methylenedioxymethamphetamine and psilocybin may show promise in highly selected populations when administered in closely supervised settings and with intensive support.
Further research warranted to confirm findings

Meta-Analysis

DOI

Intake and adequacy of the vegan diet. A systematic review of the evidence

Bakaloudi DR et al. • Clinical nutrition (Edinburgh, Scotland) (2021)

Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded.

Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded.
However, low micro- and macronutrient intakes are not always associated with health impairments.
Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.

Systematic Reviewn=48

DOI

Benefits and harm of niacin and its analog for renal dialysis patients: a systematic review and meta-analysis

He YM et al. • International urology and nephrology (2014)

Niacin and its analog effectively improved phosphorus metabolism in renal dialysis patients.

Niacin significantly increased the risk of flushing [relative risk (RR) 33; 95 % CI 4.71-232.12] in these patients, while the risk of thrombocytopenia was significantly increased in the niacinamide group (RR 2.82; 95 % CI 1.14-6.94).
Niacin and its analog effectively improved phosphorus metabolism in renal dialysis patients.
However, niacin can cause flushing and niacinamide probably cause thrombocytopenia.

Meta-Analysisn=230

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