Quote from pcovers:

I read a metadata study on clinical trials using Niacin and it reported a greater than 50% dropout rate due to unacceptable levels of flushing. While niacin does work well, it is not well tolerated to quite a large population. However one may say that the flushing goes away or you get used to it, the numbers don't lie and over 50% is a huge dropout rate compared to the norm.

Probably a lot like Atkins. It may work. But only if you stay with it, and most people don’t.

The study you are referring to was published in the American Journal of Medicine in Oct. 1995. Lead researcher was L.W. Gibbons.

Niacin was originally treated as a drug and was overprescriibed at times in excess of 3 grams. This caused liver problems, increased uric acid, blood sugar elevations, and the flushing problem.

Another study published in the Archives of Family Medicine, 1996 showed that the newer sustained release Niacin improved HDL cholesterol levels by 20% when given in a dose of 1500-2000 mg. which is far lower than the original dosages.
that is why I suggested a starting dose of 100mg which is less than 1/10 the dose used in the 1996 study.

The idea is to determine the level of Niacin needed to make the desired change.

A just-published study in Archives of Internal Medicine (Guyton, et al, 2000) confirms my long-held belief in the superiority of niacin (vitamin B3) as a lipid-lowering agent. A proprietary timed-release version of niacin (Niaspan) was compared to the pharmaceutical drug gemfibrozil (Lopid).

The study involved 399 male and female subjects ranging in age from 21 to 75, all of whom had low levels of HDL (high density lipoproteins—“good cholesterol”) less than 40 mg/l. Other criteria for inclusion in this study were triglycerides less than 400 mg/l, and LDL (low density lipoproteins—“bad cholesterol”) less than 260 mg/l. Niacin was administered once daily at bedtime. The niacin dosage was begun at 375 mg/day, and then increased progressively over the course of the study, and maintained at a level of 2,000 mg nightly for 8 weeks. The duration of the study was 16 weeks. Subjects took an aspirin as-needed to prevent flushing. Gemfibrozil 600 mg was administered twice daily over the entire 16 weeks.

Niacin increased HDL levels over 25%, compared to an increase of 13.3% due to gemfibrozil. Gemfibrozil actually raised LDL (the “bad” cholesterol, remember?), while niacin slightly lowered this fraction. Gemfibrozil lowered triglyceride levels by 40%, compared to a 30% decrease from niacin. Thus, niacin resulted in an overall improvement in the lipid profile which exceeded that induced by gemfibrozil.

Quote from RMiller:

Niacin was originally treated as a drug and was overprescriibed at times in excess of 3 grams. This caused liver problems, increased uric acid, blood sugar elevations, and the flushing problem.

Another study published in the Archives of Family Medicine, 1996 showed that the newer sustained release Niacin improved HDL cholesterol levels by 20% when given in a dose of 1500-2000 mg. which is far lower than the original dosages.
that is why I suggested a starting dose of 100mg which is less than 1/10 the dose used in the 1996 study.

The idea is to determine the level of Niacin needed to make the desired change.

A just-published study in Archives of Internal Medicine (Guyton, et al, 2000) confirms my long-held belief in the superiority of niacin (vitamin B3) as a lipid-lowering agent. A proprietary timed-release version of niacin (Niaspan) was compared to the pharmaceutical drug gemfibrozil (Lopid).

The study involved 399 male and female subjects ranging in age from 21 to 75, all of whom had low levels of HDL (high density lipoproteins—“good cholesterol”) less than 40 mg/l. Other criteria for inclusion in this study were triglycerides less than 400 mg/l, and LDL (low density lipoproteins—“bad cholesterol”) less than 260 mg/l. Niacin was administered once daily at bedtime. The niacin dosage was begun at 375 mg/day, and then increased progressively over the course of the study, and maintained at a level of 2,000 mg nightly for 8 weeks. The duration of the study was 16 weeks. Subjects took an aspirin as-needed to prevent flushing. Gemfibrozil 600 mg was administered twice daily over the entire 16 weeks.

Niacin increased HDL levels over 25%, compared to an increase of 13.3% due to gemfibrozil. Gemfibrozil actually raised LDL (the “bad” cholesterol, remember?), while niacin slightly lowered this fraction. Gemfibrozil lowered triglyceride levels by 40%, compared to a 30% decrease from niacin. Thus, niacin resulted in an overall improvement in the lipid profile which exceeded that induced by gemfibrozil.

A couple comments. It looks like these studies were geared to show niacin off in the best light. Why for example, compare with gemfibrozil rather than Lipitor?
Even with this favorable comparison, the results for 2000 mg/day show 20% and 25% increases in HDL....this is, for example, a change from a wretched 30 to a wretched 36-37. Not enough to benefit most people. And then reporting "slightly lowered this fraction [LDL]" shows extreme bias by not giving a number and worse indicating the results were perhaps not as "stellar" as the 20% HDL improvement. Most people considering drug intervention need a LARGE LDL lowering.

Comparing statin risk with niacin risk (kidney damage from uric acid crystals, liver damage and blood glucose increases [in this age of diabetes]) seem to point to more risk from the niacin without even mentioning the horrors of flushing (and the risk of stomach bleeds from antiinflammatory doses of aspirin.)
Saying that 3000 mg is very risky and then recommending 2000 is just bad medicine. If 3000 hurts many, then 2000 will certainly hurt some. A horrible adverse effect is ignored completely. It is angio-edema, a life threatening condition involving the swelling of lips, tongue, and airways resulting in difficult breathing (yep, that was my "flush.")

All that said, some people in these fora have had very helpful results with various niacin formulations and if it works well and is tolerable, then go for it if you choose. But after looking long and hard, it really does seem to me that the statins are the better choice for safety and efficacy. I cut my LDL's in half after a month of lipitor. NOBODY can get results like that with niacin.

Quote from zip2play:

A couple comments. It looks like these studies were geared to show niacin off in the best light. Why for example, compare with gemfibrozil rather than Lipitor?
Even with this favorable comparison, the results for 2000 mg/day show 20% and 25% increases in HDL....this is, for example, a change from a wretched 30 to a wretched 36-37. Not enough to benefit most people. And then reporting "slightly lowered this fraction [LDL]" shows extreme bias by not giving a number and worse indicating the results were perhaps not as "stellar" as the 20% HDL improvement. Most people considering drug intervention need a LARGE LDL lowering.

Comparing statin risk with niacin risk (kidney damage from uric acid crystals, liver damage and blood glucose increases [in this age of diabetes]) seem to point to more risk from the niacin without even mentioning the horrors of flushing (and the risk of stomach bleeds from antiinflammatory doses of aspirin.)
Saying that 3000 mg is very risky and then recommending 2000 is just bad medicine. If 3000 hurts many, then 2000 will certainly hurt some. A horrible adverse effect is ignored completely. It is angio-edema, a life threatening condition involving the swelling of lips, tongue, and airways resulting in difficult breathing (yep, that was my "flush.")

All that said, some people in these fora have had very helpful results with various niacin formulations and if it works well and is tolerable, then go for it if you choose. But after looking long and hard, it really does seem to me that the statins are the better choice for safety and efficacy. I cut my LDL's in half after a month of lipitor. NOBODY can get results like that with niacin.

Truly neither is a cure-all.
Niacin can cause several problems as you have indicated.
Statins (including Lipitor) have their own nasty side effects too.
Death being the worst one.

Statins also flood the bloodstream with Free Radicals, which attach to the LDL's and clump them. Free Radical oxidation is the only way LDL can cause damage.

Statins have also been linked to elevations of LP(a), the sticky protein that attatches to LDL doubling the risk of heart disease.

In addition some statins have been pulled from the market due to their being linked to liver damage, and death.
Statins also deplete the body of COQ10, which is vital for healthy heart muscle.

I guess the only good solution is eating a good diet.