Studies using niacin alone or in combination with, for example, statins have shown cardiovascular benefit:
Niacin reduces Lp(a) levels by up to 30–40% in a dose-dependent manner and in addition exerts other potential beneficial effects by reducing LDL cholesterol, total cholesterol, triglycerides, and remnant cholesterol and by raising HDL cholesterol. In a meta-analysis including 11 randomized controlled trials with 2682 patients in the active group and 3934 in the control group, niacin 1–3 g/day reduced major coronary events by 25%, stroke by 26% and any cardiovascular event by 27%.
Nicotinic acid has been made tolerable with sustained-release formulations, and is still considered an excellent choice in elevating HDL cholesterol. It is also potentially effective in reducing lipoprotein(a) [Lp(a)] levels. Many conventionally trained physician uses niacin to reduce Lp(a). This does work to a limited extend. Niacin reduces the production of lipoprotein A in the liver, and helps to bring down the lipoprotein a in the blood. However, this approach has its limitations because until the endothelial wall is optimized and cleared, the lipoprotein A level will not be able to reduce significantly. The effects of niacin usually hit a plateau after 6-9 months of therapy. If you are on niacin, make sure the liver enzyme levels are taken periodically to make sure the liver is able to handle the high dose of the niacin.