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B39.0
Niacin Research
Probably helpsModerate safety
45 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 2007–2026 with a typical study size of 3,414 participants.
Based on 45 studies · 22 meta-analyses · 11 RCTs · 625,598 total participants
Confidence
High
What the studies found
8helped5unclear2didn't help· 30 more without graded effect data
By outcome
Cholesterol & lipidsRaises HDL and modifies lipid profiles at pharmacological doses · 4-8 weeks
Probably helps31 studies
Heart & blood pressureRaises HDL and modifies lipid profiles at pharmacological doses · 4-8 weeks
Probably helps9 studies
Skin health
Probably helps9 studies
Longevity & agingIncreased NAD+ levels for cellular health · Ongoing
Mostly mechanism / observational7 studies
Niacin flush & tolerability
Limited support7 studies
Safety profile
Mostly mechanism / observational4 studies
Therapeutic & clinical
Mostly mechanism / observational3 studies
Glucose & metabolic
Too few graded studies2 studies
Energy & fatigue
Too few graded studies1 study
Neuroprotection & brain aging
Too few graded studies1 study
By the numbers
Pulled from 39 studies with measurable effects
Likely real effects
82%
across studies
People studied
626k
typical study: 3414 people
Strongest designs
33
22 pooled, 11 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
Active research area
27 studies in the last 5 years · Latest meta-analysis: 2025
200720162026
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).
10Systematic ReviewCited 11×n=118 · medium study2023
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.
Nogueira-de-Almeida CA et al. · Central nervous system agents in medicinal chemistry (2023)
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.
11Vascular inflammation and cardiovascular disease riskMeta-AnalysisCited 85×2024
Ferrell M et al. · Nature medicine (2024)
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.
12Daily dietary niacin intake in glaucoma patientsMeta-AnalysisCited 7×2024
Daily dietary intake of niacin is significantly lower in patients with glaucoma compared to the general population.
Nicola CA et al. · Nutrients (2024)
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.
13Keratinocyte cancer preventionMeta-AnalysisCited 13×2023
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.
Tosti G et al. · Nutrients (2023)
No clear effect
← WorseNo effectBetter →
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.
14Major vascular events per 1-mmol/L LDL-C reductionMeta-AnalysisCited 1,123×n=175 · medium study2016
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.
Silverman MG et al. · JAMA (2016)
Noticeable benefit
← WorseNo effectBetter →
Likely real
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.
15C-reactive protein levelsMeta-AnalysisCited 5×2024
Niacin treatment is associated with significant reductions in CRP and TNF-α levels, suggesting potential anti-inflammatory effects.
Rad EY et al. · European journal of nutrition (2024)
Huge benefit
← WorseNo effectBetter →
Likely real
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.
17Phosphorus metabolism and adverse eventsMeta-AnalysisCited 13×n=230 · medium study2014
Niacin and its analog effectively improved phosphorus metabolism in renal dialysis patients.
He YM et al. · International urology and nephrology (2014)
Huge harm
← WorseNo effectBetter →
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.
18Flow-mediated dilation (FMD)Meta-AnalysisCited 25×n=441 · medium study2014
In conclusion, treatment with niacin improves endothelial function.
Sahebkar A · Vascular medicine (London, England) (2014)
Noticeable benefit
← WorseNo effectBetter →
Likely real
Pooled effects were measured by weighted mean difference (WMD) and 95% confidence intervals (CIs).
Niacin therapy significantly improved FMD (WMD: 1.98%; 95% CI: 0.91-3.05%; p = 0.0003) and this effect was robust in the sensitivity analysis.
The effect size was greater in the subgroup of studies administering higher doses of niacin (≥ 2000 mg/day) as well as those studies administering niacin for primary prevention of ACVD.
This updated review shows similar findings to the previous report for preventive benefits from both folic acid and B vitamins for stroke and has been graded with moderate quality.
Jenkins DJA et al. · Journal of the American College of Cardiology (2021)
This updated review shows similar findings to the previous report for preventive benefits from both folic acid and B vitamins for stroke and has been graded with moderate quality.
No effect was seen for the commonly used multivitamins, vitamin D, calcium, and vitamin C, and an increased risk was seen with niacin (with statin) for all-cause mortality.
Conclusive evidence for the benefit of supplements across different dietary backgrounds, when the nutrient is sufficient, has not been demonstrated.