Why has niacin fallen out of favor despite favorable HDL-C effects?

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Multiple Choice

Why has niacin fallen out of favor despite favorable HDL-C effects?

Raising HDL-C with niacin doesn’t reliably translate into fewer cardiovascular events, and the drug brings bothersome and sometimes serious side effects. Large trials adding niacin to statin therapy showed little to no reduction in major cardiovascular outcomes, and patients often couldn’t tolerate it because of flushing, itching, liver toxicity, and worsening glucose control. Because the potential benefit in risk reduction is not demonstrated and the downsides are real and common, niacin fell out of favor as a general cardiovascular therapy. In short, the limited CV benefit seen in trials, combined with significant adverse effects, explains why it’s no longer a preferred option.

Raising HDL-C with niacin doesn’t reliably translate into fewer cardiovascular events, and the drug brings bothersome and sometimes serious side effects. Large trials adding niacin to statin therapy showed little to no reduction in major cardiovascular outcomes, and patients often couldn’t tolerate it because of flushing, itching, liver toxicity, and worsening glucose control. Because the potential benefit in risk reduction is not demonstrated and the downsides are real and common, niacin fell out of favor as a general cardiovascular therapy. In short, the limited CV benefit seen in trials, combined with significant adverse effects, explains why it’s no longer a preferred option.

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