The Drug’s The Problem In Heart Study, Not Vitamin B3

| September 4, 2014

What would you think if you saw the news headline “Niacin Could Have Risks as Cholesterol Therapy”? Or, “Niacin May Be Too Risky As Heart Drug, Reports Find”? Or “Niacin Therapy Shows No Benefits, Has Some Harmful Effects”? You could be forgiven for believing that taking niacin, also known as vitamin B3, had suddenly been revealed to have some dangerous side effects. In fact, though, nothing could be further from the truth.

These and other similarly alarming headlines appeared recently in the reporting of a large clinical trial in which a combination of niacin and a drug called laropiprant was given to patients with a previous history of heart or arterial disease and who were considered to be at high risk of suffering a heart attack or stroke. The study found that, compared with placebo, the treatment did not reduce the risks of these ‘major vascular events’. But it did have adverse side effects, including an increased incidence of new cases of type 2 diabetes, poorer control of existing diabetes, gastrointestinal problems and muscle or joint pains.1

High dose niacin has been used safely for more than 60 years, with successive reviews of clinical trials concluding that it has a “remarkably consistent record of benefit” in treating cardiovascular disease2 and is associated with a “significant reduction” in heart attacks and other cardiovascular events.3 So why haven’t any concerns been raised about niacin before now?

The truth is that the latest study says absolutely nothing about the safety of niacin. What didn’t get reported in the press was that when the researchers conducted a parallel trial of niacin without laropiprant, they didn’t see the same side effects.4 The problems seen with the combination therapy were not due to the niacin, of course, but to laropiprant, a drug added to niacin to reduce the vitamin’s harmless but inconvenient side effect of a facial flush.

Laropiprant is already known to be so dangerous that it has been banned in most countries in the world. US regulators refused to approve it in 2008, while its authorisation in the EU was withdrawn in March 2013. It is only still available in the UK, Scandinavia and China, which is where the patients for the latest study were recruited.

Laropiprant blocks the action of a body chemical called prostaglandin D2 (PGD2), which is responsible for the facial flush that some people experience with high doses of niacin. However, PGD2 has many other roles, including dilation of the blood vessels, an important factor in cardiovascular health. Recent animal studies have found that PGD2 also helps to protect the heart from damage during a heart attack.5 So, it looks like laropiprant actually works against the heart-healthy effects of niacin.

Instead of blaming niacin, why weren’t those media reports pointing the finger firmly at the real culprit, laropiprant? You’ve probably already guessed; laropiprant is made by the pharmaceuticals giant Merck – and Merck just happens to have provided the funding for the niacin/laropiprant study.

So you can bet that Merck’s powerful PR machine was working overtime to limit the damage from the disastrous results of this trial; and what better than to deflect attention away from their poisonous patent medicine and onto the innocent vitamin instead? And as those headlines show, the international news feeds fell for it hook, line and sinker.

The truth about B-vitamins

In fact, all of the B-vitamins are vital for heart health, particularly for people with diabetes or metabolic syndrome. In particular:

  • Vitamin B1 (thiamine) is essential for proper heart function and for the production of nitric oxide, which dilates the arteries. Vitamin B1 deficiency is common in diabetics and can lead to neuropathy, kidney damage, retinopathy and heart failure.
  • Vitamin B3 (niacin) has been shown in many studies to reduce cardiovascular risks, increase levels of the good kind of cholesterol (HDL-C) and to be of particular benefit in people with diabetes.
  • Vitamin B6 deficiency is also common in diabetes. This vitamin is essential for blood sugar control, arterial health and protecting against the damage caused by ‘advanced glycation end products’ (AGEs) formed when blood sugar is high.
  • Vitamin B12 reduces levels of homocysteine, a compound that is considered a better marker for heart disease risk than LDL cholesterol. It also protects the nerves against damage that can lead to diabetic neuropathy.

Taking a vitamin B-complex supplement that provides 50 mg a day of each of the vitamins B1, B3 and B6, together with 50 mcg of vitamin B12, is unlikely to cause a facial flush or any other adverse side effects and will ensure that you don’t go short of these vital nutrients.

In my next blog post, I’ll be telling you about another natural nutrient, GABA (gamma-amino butyric acid), that may be able to do things that drugs simply can’t  – such as reversing both type 1 and type 2 diabetes!

Wishing you the best of health,

Martin Hum
PhD DHD Nutritionist
for Real Diabetes Truth

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Bear in mind we are not addressing anyone’s personal situation and you should rely on this for informational purposes only. Please consult with your own physician before acting on any recommendations contained herein.


1.    Landray MJ, Haynes R, Hopewell JC et al. Effects of extended-release niacin with laropiprant in high-risk patients. N Engl J Med. 2014; 371(3):203-212.
2.    Guyton JR. Niacin in cardiovascular prevention: mechanisms, efficacy, and safety. Curr Opin Lipidol. 2007; 18(4):415-420.
3.    Lavigne PM, Karas RH. The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol. 2013; 61(4):440-446.
4.    HPS2-THRIVE Collaborative Group. HPS2-THRIVE randomized placebo-controlled trial in 25,673 high-risk patients of ER niacin/laropiprant: trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment. Eur Heart J. 2013; 34(17):1279-1291.
5.    Katsumata Y, Shinmura K, Sugiura Y et al. Endogenous prostaglandin D2 and its metabolites protect the heart against ischemia-reperfusion injury by activating Nrf2. Hypertension. 2014; 63(1):80-87. 

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Category: Diabetes and Heart Disease

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