Heart Doc VIP with Dr. Joel Kahn Episode 472: Is There Any Role for Niacin Therapy?
Dec 16, 2025
A fresh perspective on niacin therapy is explored, highlighting its potential benefits for cholesterol management despite a shift away from its use by clinicians. Interesting studies link orange juice to improved heart health and uterine fibroids to increased cardiovascular risks. The podcast also emphasizes the importance of prediabetes remission in reducing heart events and examines the role of Tartary buckwheat in slowing aging. Additionally, there's a look at how long-term statin use may affect muscle strength, alongside practical recommendations for heart health.
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Protect Muscle While On Statins
- Talk to your doctor about using the lowest effective statin dose and consider adding ezetimibe to reduce statin exposure.
- Take coenzyme Q10 (around 400 mg/day) and prioritize regular strength training to protect muscle mass while on statins.
Niacin's Benefits Depend On Context
- Historical trials show niacin alone reduced heart attacks, strokes, and long-term mortality in pre-statin eras.
- Modern trials added niacin to high-dose statins and showed no added benefit, explaining the controversy.
Modern Trials Tested Niacin With High-Dose Statins
- Large modern trials (HPS2-THRIVE, AIM-HIGH) tested niacin added to intensive statin therapy and did not show outcome benefit.
- HPS2-THRIVE used a niacin plus laropiprant combo that caused tolerability and safety problems, complicating interpretation.