### Can Taking Niacin Supplements Increase the Risk of Heart Disease? A recent study published in the journal Nature Medicine suggests that taking B vitamin supplements containing niacin (Vitamin B3 or nicotinic acid) could increase the risk of heart disease. The study, led by researchers from the Cleveland Clinic, found that up to 1 in 4 people have higher-than-recommended levels of niacin. While niacin was once recommended to lower cholesterol, it has been largely replaced by more effective statin drugs. When the body breaks down niacin, it produces a byproduct called 4PY, which triggers inflammation in the circulatory system. This inflammation can damage blood vessels and lead to atherosclerosis, a condition where plaque builds up in the arteries. Atherosclerosis significantly raises the risk of stroke, heart attack, and other major heart problems. Dr. Stanley Hazen, the senior author of the study, advises that the average person should avoid niacin supplements due to the potential increased risk of cardiovascular disease. The researchers conducted the study because they suspected there were unknown risks of heart disease, even among people who follow all recommended preventive measures like eating healthy, exercising, and managing weight, blood pressure, and blood sugar. The study analyzed the blood of several thousand people, both those who were stable but monitored for heart problems and a broader population. All analyses indicated higher risks of heart problems linked to excess niacin. The findings help explain the “niacin paradox,” where niacin lowers cholesterol but does not provide the expected clinical benefits, and sometimes even increases the risk of diabetes, brain bleeding, skin problems, and gut issues. Niacin has been added to products like flour and fortified cereals since the early 20th century to prevent pellagra, a condition caused by niacin deficiency. Symptoms of pellagra include skin problems, diarrhea, and dementia, and it can be deadly. Dr. Hazen suggests that while we shouldn't eliminate niacin intake entirely, there should be a discussion about whether the continued fortification of flour and cereals with niacin in the U.S. is warranted.