Does it make sense to take vitamin pills? Keep reading to learn more about a systematic review from several years ago. First, though, we want to address some very confusing recent research that implied niacin might increase the risk of heart problems.
Does Niacin Cause Heart Problems?
Q. On the news last week, there was a segment about niacin supplements causing heart disease in mice. I have taken B complex supplements for years. Vitamin B6 was supposed to help with my energy level after being diagnosed with fibromyalgia. I think I used to hear niacin mentioned as helping with cholesterol, so I hoped the B complex would help with that, too.
I have few fibromyalgia symptoms today, so I may not need the B complex any more. Have you heard anything about problems with niacin?
A Confusing Story on Niacin:
A. The niacin story is incredibly complicated. First, some basic biochemistry. Niacin (nicotinic acid) is an essential nutrient. People who are deficient in this B3 vitamin can develop a serious health condition called pellagra. That rarely happens now in places like the US because refined grains are fortified with B vitamins.
The body converts niacin from the diet into its active form, nicotinamide adenine dinucleotide (NAD). This coenzyme is crucial for hundreds of biochemical reactions in the body.
Niacin as Medicine:
Prior to the development of statins, doctors used to prescribe high-dose niacin to lower LDL cholesterol and raise so-called good HDL cholesterol.
One of the largest studies of supplemental niacin was called the Coronary Drug Project (Journal of the American College of Cardiology, Dec. 1986). It was conducted between 1966 and 1975 and involved thousands of men who had experienced a heart attack.
Some took 3 grams of niacin a day–a large dose–and others took placebo. During the study itself, men taking niacin were less likely to have repeat heart attacks, but they were no less likely to die. A fifteen-year follow-up, however, showed that men who had been taking niacin had an 11 percent lower mortality rate than those on placebo.
Fast forward 50 years to the study you refer to (Nature Medicine, Feb. 19, 2024). The authors did not perform a clinical trial involving supplemental niacin. Instead, they examined metabolites of niacin in the bloodstream.
The researchers found an association between high levels of these metabolites, possibly from dietary niacin, and the risk of heart attacks. They also dosed mice with the metabolites, known as 2PY and 4PY. Those mice increased production of a protein that can cause white blood cells to stick to the lining of blood vessels. This is a first step in the development of arterial plaque, but it is still a long way from showing that niacin is dangerous. More research is needed before we will know if supplemental B vitamins or niacin-fortified foods lead to heart problems under certain circumstances.
Do Supplements Prevent Heart Problems?
Previously, scientists had analyzed 179 recent studies of commonly used supplements to see whether any of these pills helped ward off heart problems (Journal of the American College of Cardiology, June 2018). Frequently, people begin taking supplements because they have heard or read that the pills will help them stay healthy.The scientists found that none of the four most popular supplements had any impact on cardiovascular disease. (These are multivitamins, vitamin D, calcium and vitamin C.)
Folic Acid May Help:
The data revealed that folic acid and B vitamin complex supplements containing folic acid were associated with a slightly reduced risk of stroke. People taking folic acid were also slightly less likely to have heart attacks.
Don’t Mix Niacin with a Statin:
On the other hand, a different B vitamin, niacin, is often taken at high doses of up to 3 grams a day to lower cholesterol. When niacin is taken together with a cholesterol-lowering statin, the risk of premature death from any cause increases by about 10 percent. The authors suggest that we should avoid taking niacin together with a statin to lower cholesterol.
Antioxidants Are Not Beneficial:
The scientists also evaluated the effects of high-dose antioxidants (vitamins A, C, E, β-carotene, selenium and zinc). These had no impact on heart problems. However, people taking them were slightly more likely to die prematurely. The calculation is that for every 250 people taking such a combination, one person would die early.
The Bottom Line on Supplements for Heart Problems:
The investigators didn’t find that supplements harm people, but they also don’t appear to help much.
Instead, the scientists strongly urge people
“to focus on healthy dietary patterns, with an increased proportion of plant foods in which many of these required vitamins and minerals can be found.”
Learn More:
Most of the experts we consult stress the value of whole foods that do not require fortification to make up for over-processing. If you would like to learn more about utilizing vitamins to ward off heart problems, you may be interested in our interview with Dr. Sam Tsimikas about Lp(a). It is Show 1036: The Best-Kept Secret in Heart Disease.
