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"), 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. However, niacin favorably altered several other cardiovascular risk factors as well.
- Apolipoprotein levels were significantly (20%) reduced by niacin, but were not altered by gemfibrozil.
- Both substances reduced serum apolipoprotein levels by the same amount.
- Fibrinogen, a third risk factor, was reduced by niacin, but increased 6-9% by gemfibrozil. The authors concluded, "Niaspan, 2,000 mg, had a significantly better effect on fibrinogen levels than gemfibrozil."
For example, in the Coronary Drug Project, which enrolled men with a previous myocardial infarction, niacin use resulted in a 26% decrease in second non-fatal heart attacks over a six-year period, and an 11% decrease in total mortality after 15 years of followup.
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