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Question:
My HDL (good) cholesterol level is low. Should I take niacin to raise my HDLs?

Answer:
Niacin, at very high doses, can raise HDL levels, as well as lower elevated triglycerides -- both of which would seem to be good objectives, since higher HDL levels are generally associated with reduced risk coronary artery disease, as are lower triglyceride levels. However, it's not necessarily a good idea to take niacin to raise HDLs and there are safer ways to boost HDL levels. See the full answer >>

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COMMENTS

Bruce8606   April 4, 2016
The Corsetti article is also a retrospective review of a number of subgroups of patients postinfarction with high CRP and cholesterol. Some of these patients also had elevated HDL; these patients supposedly were at greater risk for recurrent coronary events. Patients were selected from a database using a previously described complex computer program that stratified patients into a number of different subgroups. The method for stratifying the patients to be included in the study was based on unnamed criteria, analyzed on the same unknown basis, and then comparisons were made between the subgroups. Since the subgroups were selected precisely because use of these groups would show ab association in favor of the hypothesis. The authors must be far more transparent in discussing their research in order that others might preform a critical review and be able to verify its validity.

Robert8595   April 3, 2016
This is good advice, especially when considering supplementing with niacin at levels approaching 1,000 mg./day.

I would add another point that was partially addressed but may deserve separate consideration. Individual reactions vary. For some, supplemental niacin can have adverse effects on blood sugar and insulin sensitivity in doses as low as 750 mg./day. Even if niacin makes sense for your situation, you would want to know how niacin affects you before considering a high dose.

More important is that chasing HDL levels may not be a good idea in all cases. In fact, it is bad science. The inverse correlation between HDL and heart attacks is low and logically weak. Depending on how you count, from one-half to three-fourths of heart attack victims have normal cholesterol metrics and a comparable proportion of those who are "at risk' based on cholesterol metrics never have a heart attack. What this suggests to an impartial scientist is that the portion of the medical community that promulgates guidelines has its eye on the wrong metrics -- metrics that were derived initially after Eisenhower suffered his heart attack.

The best science today says that cholesterol particle count and triglycerides (combined with certain genetic profiles) are better but still imperfect leading predictors of the progression of CV disease. Even so, there are many other factors and the findings are certain to change as we learn more.

The best prevention remains: exercising, maintaining healthy body weight & blood sugar levels, consuming only high quality fats, managing negative stress, and maintaining a blood pressure that is appropriate for you (current BP guidelines will push 10-20% of healthy people into taking unhealthy medication that has yet to demonstrate positive outcomes).


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This CL Answer initially posted on 4/2/2016. Last updated 8/2/2017.
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