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Niacin prescriptions increasing in Canada and the US despite no new evidence of benefit


Niacin use has rapidly increased in the US and Canada, even relative to statin use. Researchers at the Institute for Clinical Evaluative Sciences (ICES) have found that per capita niacin use in the US is nearly six-fold larger than in Canada.

Niacin, also known as vitamin B3, has been used for many years for its effects on lowering LDL, or “bad” cholesterol, and raising HDL, or “good” cholesterol, in people at high risk for heart attack and stroke. However, there is limited evidence that niacin reduces the risk of heart attack and stroke, especially when added to current cholesterol-lowering therapy.

“Two large trials have failed to show the clinical benefit of niacin in patients already using statins. In this study we wanted to examine how much Canada and the United States are using and spending on this drug,” says Cynthia Jackevicius, lead author of the study and adjunct scientist at ICES.

  • The population-level observational cohort study from 2002 to 2009 found that:
  • Niacin is prescribed six times more frequently in the US than in Canada.
  • The cost of prescription niacin is seven times higher in the US than in Canada.
  • Over the last 5 years of the study, a total of $3.4 billion was spent on prescription niacin in the US.
  • Niacin prescriptions are increasing in both countries despite recent studies showing little evidence of benefit.

“Even though relative rates of increase in niacin use are similar between the countries, niacin is used about 6 times more frequently in the US than Canada. Factors that may play a role in its differential use include guidelines, product availability and marketing,” says Jackevicius, who is also an associate professor at Western University of Health Sciences in California.

The study “Use of Niacin in the United States and Canada” was published today in JAMA Internal Medicine.

Authors: Cynthia A. Jackevicius, Jack V. Tu, Joseph S. Ross, Dennis T. Ko, Noelle de Leon, Harlan M. Krumholz.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.



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