Niacin (nicotinic acid) is both effective and cheap. It is often used with bile sequestrants for better cholesterol control. It lowers LDL, IDL, and VLDL, and raises HDL. It also lowers triglycerides and is therefore useful in most types of hyperlipidemia (2, 4, and 5). Data from the Coronary Drug Project (Canner, et al. 1986) showed men with previous heart attacks using niacin had decreased rates of new infarction and lowered mortality; the use of niacin can extend life in those with coronary heart disease.
Since large doses of niacin are required, side effects are its biggest drawback. These include liver enzyme elevations, rashes, nausea, vomiting, flushing, and worsening of gout and diabetes. The intense flushing can be managed by taking an aspirin before taking the niacin, which blocks the prostaglandin-mediated flushing response. Lanolin creams help dry skin, but clearing rashes requires stopping the drug. In general, side effects can be minimized by starting at low doses and working up slowly. Your doctor will want to pace your niacin intake and test your liver enzymes periodically.
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