Does niacin or niacinamide help with high cholesterol?

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Michael J. Bloch, MD
Internal Medicine
Niacin (or nicotinic acid), which is available either over the counter or as a prescription medication, has multiple effects on the cholesterol panel. The most notable effect of nicotinic acid is on raising the HDL-C (or good) cholesterol. It can also have a significant effect in reducing triglycerides and a modest effect on lowering LDL-C (or bad) cholesterol. Importantly, use of nicotinic acid also has effects on the size and density of LDL cholesterol, making the LDL molecules bigger and 'fluffier,' which may make them less likely to cause heart disease. Nicotinic acid can be used either alone or in combination with other medications, like statins. Like all medications, nicotinic acid may be associated with significant side effects, including flushing, and those risks may be increased when it is used in combination with other cholesterol-lowering medications. Be sure to discuss all medications and supplements with your personal health care provider.