The name nicotinic acid was changed to niacin in the 1940s to avoid any confusion with nicotine.

Either name has to be better than the original moniker, though, vitamin Pee-B Pallagra-preventing.

In the 1950s, NA became the world's first cholesterol-lowering drug.

This led more than 20 trials involving tens of thousands of individuals taking high doses of

N.A. for up to six years, resulting in by far the most robust safety data we have on any

of the N&D precursors.

The most striking benefit was found in the coronary drug project,

a trial carried out in the pre-statin drug era, the 1960s and 70s.

The 15-year follow-up found that those who had been randomized to years of high-dose N.A.

ended up with a 6.2% drop in absolute mortality. Fifty-two percent died in

the N.A. group versus 58 percent in the placebo group. This sparked major clinical trials.

That, sadly, failed so spectacularly that one was even stopped prematurely. All in all,

a Cochrane meta-analysis concluded that no evidence

of benefits from niacin therapy was found. One possible explanation for the contrasting results is that

the early promising trials used immediate release niacin, while the newer failed trials used slow-release formulations, also known

as extended or sustained release.

At high doses, regular niacin commonly causes an intense flushing redness and prickly heat

sensation similar to a menopausal hot flash.

A slow-release version was developed to reduce this flushing reaction,

catapulting it into a billion-dollar blockbuster drug, but it simply doesn't work as well

to lower cholesterol. The major clinical trial failures led to the withdrawal of the drug in

Europe and the removal from U.S. clinical guidelines for cardiovascular

...