Key findings from detailed records
Vitamin B3 forms have different evidence. Nicotinamide 500 mg 2 times daily reduced the rate of new nonmelanoma skin cancers by 23% relative to placebo over 12 months in 386 people with repeated prior skin cancers. High-dose nicotinic acid did not add cardiovascular-event benefit to statin therapy in large trials.
KNOWLEDGE RECORD
- Category
- Vitamins and minerals
- Last Reviewed
- 2026-09-27
Names and related search termsNicotinic acid; nicotinamide; niacinamide; vitamin B3; niacin equivalents
OUTCOME-SPECIFIC EVIDENCE
Scientific Evidence Profile
Assessment pending
An outcome-specific assessment has not yet been completed. This is not a finding that the ingredient is ineffective. The study records below remain available.
This profile concerns the stated outcome and population, not the ingredient as a whole. It is not a probability of benefit, a safety rating, a product efficacy rating or an indication of product adoption.
How we assess evidenceIngredient Profile
- What is it, and where is it found?
- Niacin is vitamin B3. Nicotinic acid and nicotinamide are different forms; the form used matters when interpreting both effects and adverse events. [1]
Sources for this profile
Compound properties and formulation properties are different. These sources do not establish the efficacy of a finished supplement.
- NIH Office of Dietary Supplements — Niacin Nutrient identity and food-source reference. Published by NIH Office of Dietary Supplements. Reference synthesis; not an individual clinical trial.
Profile sources checked:
Read the evidence in context
- Evidence: what was measured in the stated population or experimental model.
- Inference: an interpretation connecting findings; its applicability depends on the study conditions.
- Hypothesis: a proposed explanation or effect that remains to be tested.
Why It Matters #
Niacin is vitamin B3, needed to form NAD and NADP. Nicotinic acid and nicotinamide (niacinamide) can meet nutritional needs, but their pharmacological actions differ. Adult recommended intake is 14 mg niacin equivalents/day for women and 16 mg for men; niacin equivalents account for tryptophan conversion. Deficiency prevention should not be confused with gram-dose therapy.[11]
What Was Studied #
Cardiovascular trials tested extended-release nicotinic acid in people already receiving lipid treatment. Other research examines niacin in mitochondrial myopathy or nicotinamide in people at high risk of skin cancer. These are different interventions, populations and endpoints. NMN and nicotinamide riboside are separate NAD precursors and are not synonyms for niacin.[2][3][4][5]
What Was Found #
In HPS2-THRIVE, niacin plus laropiprant did not significantly reduce major vascular events beyond statin-based treatment: 13.2% versus 13.7% over a median 3.9 years. Serious problems with diabetes control and several other adverse outcomes increased. AIM-HIGH likewise found no incremental cardiovascular benefit despite better lipid values.[2][3]
By contrast, ONTRAC found a 23% lower rate of new nonmelanoma skin cancers during 12 months of nicotinamide 500 mg twice daily in adults with repeated prior skin cancers. This was a relative reduction in a selected high-risk population, not a general cancer-prevention finding. Small myopathy research also reported restoration of deficient NAD measures, addressing a disease-specific deficit.[5][4]
What the Evidence Means #
The essential nutrient has a clear role in adequacy. Additional supplementation must be judged against its own endpoint. Better HDL or NAD measurements are not substitutes for fewer events or sustained function. The high-dose cardiovascular results also should not be extrapolated to ordinary dietary niacin.
What We Can Learn #
Form and dose are safety variables. Nicotinic acid can cause flushing even at tens of milligrams; pharmacological doses can affect glucose regulation, liver function and uric acid. Nicotinamide does not have the same flushing and lipid effects, but high-dose use still requires its own safety assessment. The NIH fact sheet separates these forms and their dose-related risks.[11]
What Remains Unknown #
Whether raising NAD with extra B3 preserves long-term function in nutrient-sufficient healthy adults remains unresolved. Trials need baseline nutritional/NAD status, defined chemical form and meaningful functional outcomes. Results from myopathy or high-risk skin-cancer populations cannot determine a universal longevity dose.
LITERATURE MAP / 10 PAPERS
Compare papers by conditions and findings.
Compare populations, preparations, doses and outcomes. Detailed records below assess selected studies; the remaining entries provide a bibliographic route into related questions.
Selected: 2026-09-27. Bibliographic information checked against Europe PMC / PubMed. This editorial selection includes major trials, evidence syntheses and different research questions; it is not an exhaustive systematic review. Paper counts are not counts of independent trials.
10 RECORDS
A dash marks fields not assessed in a bibliographic-only record.
| Paper and topic | Study conditions | Findings and scope |
|---|---|---|
| Niacin for primary and secondary prevention of cardiovascular events.PMID 28616955 # | Study conditions — | Findings and scope — Open original paper |
| Detailed recordEffects of extended-release niacin with laropiprant in high-risk patients.PMID 25014686 # | Study conditions HPS2-THRIVE: randomized, placebo-controlled outcomes trial
| Findings and scope Major events: 13.2% versus 13.7%; rate ratio 0.96 (95% CI 0.90–1.03). Serious disturbances of diabetes control increased by 3.7 percentage points. Read detailed record |
| Detailed recordNiacin in patients with low HDL cholesterol levels receiving intensive statin therapy.PMID 22085343 # | Study conditions AIM-HIGH: randomized, placebo-controlled trial
| Findings and scope Primary events: 16.4% versus 16.2%; hazard ratio 1.02 (95% CI 0.87–1.21), despite improved HDL and triglycerides. Read detailed record |
| Niacin Cures Systemic NAD+ Deficiency and Improves Muscle Performance in Adult-Onset Mitochondrial Myopathy.PMID 32386566 # | Study conditions — | Findings and scope — Open original paperA published correction is linked in PubMed (PMID 32640244). |
| Detailed recordA Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention.PMID 26488693 # | Study conditions ONTRAC: randomized, double-blind, placebo-controlled trial
| Findings and scope 23% lower rate during treatment (95% CI 4–38% lower). Read detailed record |
| Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes: A Systematic Review and Meta-analysis.PMID 30977858 # | Study conditions — | Findings and scope — Open original paper |
| Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomised controlled trials.PMID 26370223 # | Study conditions — | Findings and scope — Open original paper |
| Serious Adverse Effects of Extended-release Niacin/Laropiprant: Results From the Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE) Trial.PMID 31447131 # | Study conditions — | Findings and scope — Open original paper |
| Safety profile of extended-release niacin in the AIM-HIGH trial.PMID 25014706 # | Study conditions — | Findings and scope — Open original paper |
| HPS2-THRIVE randomized placebo-controlled trial in 25 673 high-risk patients of ER niacin/laropiprant: trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment.PMID 23444397 # | Study conditions — | Findings and scope — Open original paper |
No papers match. Change the search conditions.
Explore the research Study Records
Listed doses describe study conditions, not recommended intake.
Effects of extended-release niacin with laropiprant in high-risk patients.
PubMed 25014686 DOI: 10.1056/nejmoa1300955
- Authors
- HPS2-THRIVE Collaborative Group, Landray MJ, Haynes R, Hopewell JC, Parish S, Aung T, Tomson J, Wallendszus K, Craig M, Jiang L, Collins R, Armitage J.
- Journal
- The New England journal of medicine
- Publication year
- 2014
- Study design
- HPS2-THRIVE: randomized, placebo-controlled outcomes trial
- Participants
- 25,673 adults with vascular disease receiving statin-based treatment
- Dose and intervention
- Extended-release nicotinic acid 2 g/day plus laropiprant 40 mg/day versus placebo
- Duration
- Median 3.9 years
- Outcomes and their role in the study
- Major vascular events; serious adverse events
- Findings
- Major events: 13.2% versus 13.7%; rate ratio 0.96 (95% CI 0.90–1.03). Serious disturbances of diabetes control increased by 3.7 percentage points.
- Limitations
- Combination intervention; vascular-disease population on background lipid therapy. Results cannot be assigned to dietary niacin or nicotinamide.
- Funding
- Merck and other support reported; the companion design report describes the grant to Oxford.
- Conflict of Interest
- The design report describes independent trial conduct/analysis and the coordinating unit’s policy against personal industry honoraria; not a claim of no commercial involvement.
- What We Can Learn
- Changes in lipid biomarkers did not produce an incremental event benefit.
- Scope of source review
- Original abstract and bibliographic record reviewed; unavailable full-text details are not inferred.
Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy.
PubMed 22085343 DOI: 10.1056/nejmoa1107579
- Authors
- AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, Koprowicz K, McBride R, Teo K, Weintraub W.
- Journal
- The New England journal of medicine
- Publication year
- 2011
- Study design
- AIM-HIGH: randomized, placebo-controlled trial
- Participants
- 3,414 patients with established cardiovascular disease
- Dose and intervention
- Extended-release niacin 1,500–2,000 mg/day on statin therapy versus control
- Duration
- Approximately 3 years
- Outcomes and their role in the study
- Composite cardiovascular events
- Findings
- Primary events: 16.4% versus 16.2%; hazard ratio 1.02 (95% CI 0.87–1.21), despite improved HDL and triglycerides.
- Limitations
- Disease population receiving contemporary lipid treatment; does not test deficiency correction.
- Funding
- US National Heart, Lung, and Blood Institute and Abbott Laboratories.
- Conflict of Interest
- Not verified in the source material available for this record.
- What We Can Learn
- An improved laboratory profile need not mean better clinical outcomes.
- Scope of source review
- Original abstract and bibliographic record reviewed; unavailable full-text details are not inferred.
A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention.
PubMed 26488693 DOI: 10.1056/nejmoa1506197
- Authors
- Chen AC, Martin AJ, Choy B, Fernández-Peñas P, Dalziell RA, McKenzie CA, Scolyer RA, Dhillon HM, Vardy JL, Kricker A, St George G, Chinniah N, Halliday GM, Damian DL.
- Journal
- The New England journal of medicine
- Publication year
- 2015
- Study design
- ONTRAC: randomized, double-blind, placebo-controlled trial
- Participants
- 386 adults with at least two nonmelanoma skin cancers in the previous five years
- Dose and intervention
- Nicotinamide 500 mg twice daily versus placebo
- Duration
- 12 months of treatment; follow-up continued afterward
- Outcomes and their role in the study
- Rate of new nonmelanoma skin cancers
- Findings
- 23% lower rate during treatment (95% CI 4–38% lower).
- Limitations
- Selected high-risk population; relative rate reduction, not 23 percentage points and not evidence for preventing all cancers.
- Funding
- Australian NHMRC funding. Blackmores donated nicotinamide and placebo tablets and had no reported role in design, data collection or analysis, manuscript review or submission.
- Conflict of Interest
- Not verified in the source material available for this record.
- What We Can Learn
- Nicotinamide has a specific clinical evidence base distinct from nicotinic-acid lipid trials.
- Scope of source review
- Original abstract and bibliographic record reviewed; unavailable full-text details are not inferred.
Cite this page
LÍFSVARÐA. Niacin / Vitamin B3: When do nutrient adequacy, NAD biology and high-dose therapy differ? Version 1.0 / Updated 2026-10-24
https://lifsvarda.com/knowledge/niacin/Edited by LÍFSVARÐA (product brand). Editorial policy
Primary Sources and updates
- Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. (2017). Niacin for primary and secondary prevention of cardiovascular events. The Cochrane database of systematic reviews DOI: 10.1002/14651858.cd009744.pub2Bibliographic record; not a detailed study appraisal.
- HPS2-THRIVE Collaborative Group, Landray MJ, Haynes R, Hopewell JC, Parish S, Aung T, Tomson J, Wallendszus K, Craig M, Jiang L, Collins R, Armitage J. (2014). Effects of extended-release niacin with laropiprant in high-risk patients. The New England journal of medicine DOI: 10.1056/nejmoa1300955Original abstract and bibliographic record reviewed; unavailable full-text details are not inferred.
- AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, Koprowicz K, McBride R, Teo K, Weintraub W. (2011). Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. The New England journal of medicine DOI: 10.1056/nejmoa1107579Original abstract and bibliographic record reviewed; unavailable full-text details are not inferred.
- Pirinen E, Auranen M, Khan NA, Brilhante V, Urho N, Pessia A, Hakkarainen A, Kuula J, Heinonen U, Schmidt MS, Haimilahti K, Piirilä P, Lundbom N, Taskinen MR, Brenner C, Velagapudi V, Pietiläinen KH, Suomalainen A. (2020). Niacin Cures Systemic NAD+ Deficiency and Improves Muscle Performance in Adult-Onset Mitochondrial Myopathy. Cell metabolism DOI: 10.1016/j.cmet.2020.04.008Bibliographic record; not a detailed study appraisal.
- Chen AC, Martin AJ, Choy B, Fernández-Peñas P, Dalziell RA, McKenzie CA, Scolyer RA, Dhillon HM, Vardy JL, Kricker A, St George G, Chinniah N, Halliday GM, Damian DL. (2015). A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. The New England journal of medicine DOI: 10.1056/nejmoa1506197Original abstract and bibliographic record reviewed; unavailable full-text details are not inferred.
- D'Andrea E, Hey SP, Ramirez CL, Kesselheim AS. (2019). Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes: A Systematic Review and Meta-analysis. JAMA network open DOI: 10.1001/jamanetworkopen.2019.2224Bibliographic record; not a detailed study appraisal.
- Goldie C, Taylor AJ, Nguyen P, McCoy C, Zhao XQ, Preiss D. (2016). Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomised controlled trials. Heart (British Cardiac Society) DOI: 10.1136/heartjnl-2015-308055Bibliographic record; not a detailed study appraisal.
- Haynes R, Valdes-Marquez E, Hopewell JC, Chen F, Li J, Parish S, Landray MJ, Armitage J, HPS2-THRIVE Collaborative Group, HPS2-THRIVE Writing Committee members, HPS2-THRIVE Steering Committee members. (2019). Serious Adverse Effects of Extended-release Niacin/Laropiprant: Results From the Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE) Trial. Clinical therapeutics DOI: 10.1016/j.clinthera.2019.06.012Bibliographic record; not a detailed study appraisal.
- Anderson TJ, Boden WE, Desvigne-Nickens P, Fleg JL, Kashyap ML, McBride R, Probstfield JL, AIM-HIGH Investigators. (2014). Safety profile of extended-release niacin in the AIM-HIGH trial. The New England journal of medicine DOI: 10.1056/nejmc1311039Bibliographic record; not a detailed study appraisal.
- HPS2-THRIVE Collaborative Group. (2013). HPS2-THRIVE randomized placebo-controlled trial in 25 673 high-risk patients of ER niacin/laropiprant: trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment. European heart journal DOI: 10.1093/eurheartj/eht055Bibliographic record; not a detailed study appraisal.
- NIH Office of Dietary Supplements. Niacin: Fact Sheet for Health Professionals.
First published: 2026-09-27 / Version 1.0. Sources reviewed 2026-09-27. Funding and conflicts are recorded separately; an unverified disclosure is not a declaration of no funding or no conflict.