Niacin is required for the synthesis of the cofactor nicotinamide adenine dinucleotide and is therefore essential for oxidative phosphorylation in energy metabolism.
The FDA has pulled approval for niacin to treat high cholesterol. According to federal regulators, the “FDA has determined that the benefits of niacin and fenofibric acid for co-administration with statins no longer outweigh the risks, and the approvals for this indication should be withdrawn.
The Coronary Drug Project, which took place before statins came to market, found a 17% decrease in non-fatal myocardial infarction (MI) in patients using niacin. Studies such as this seem to show a benefit with regard to lowering total cholesterol and increasing high density lipoprotein (HDL).
However, more recent studies, including AIM-HIGH and HPS2-THRIVE, have shown no cardiovascular benefit by adding niacin to statin therapy. In addition, it has been shown that niacin increases blood glucose levels. Therefore it has been inferred that it may contribute to new-onset diabetes.
In light of this meta-analysis, there is evidence to suggest that therapy with niacin could increase an individual’s risk of developing diabetes.