'Avoid!' Common 'cholesterol-lowering' vitamin added to bread, meat and pasta may hike risk of heart attack

Composite image of healthy foods next to man clutching his chest

Niacin linked to an increased risk of heart attack and stroke

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Adam Chapman

By Adam Chapman

Published: 20/02/2024

- 10:27

Updated: 20/02/2024

- 10:45

High levels of niacin - an essential B vitamin - may damage blood vessels and trigger inflammation, a startling new study has found

  • Excessive niacin intake is strongly associated with the development of heart attacks, strokes and other cardiac events
  • The essential B vitamin was previously recommended for reducing high cholesterol before the introduction of statins
  • For decades, cereals and breads have been fortified with niacin
  • Experts are urging people to 'avoid' niacin supplementation in light of the findings

A common vitamin added to meat, fish, fortified cereals and breads may hike your risk of heart disease, a new study suggests.

Niacin, or vitamin B3, was previously recommended to lower high cholesterol before the introduction of statins.

Now, researchers believe the vitamin is strongly associated with the development of heart attacks, strokes and other cardiac complications.

The team, led by Dr Stanley Hazen, of the Cleveland Clinic in Ohio, attribute this effect to 4PY - a breakdown product from excess niacin.

Bread in bread basket

For decades, bread and other cereals have been fortified with niacin


The researchers were unable to determine the bright line between healthy and excessive levels of niacin but future studies will hopefully determine this distinction.

"The average person should avoid niacin supplements now that we have reason to believe that taking too much niacin can potentially lead to an increased risk of developing cardiovascular disease,” Dr Hazen said.

The advice flies in the face of previous thinking, which has long informed the UK's public health policy.
For decades, it has been a legal requirement to fortify all white flour sold in the UK with niacin.

The amount that must be added — 2.4mg per 100g — was increased by the Government in 2022.

How the researchers arrived at their findings

Dr Hazen and his colleagues set out to identify unknown risk factors for cardiovascular disease, the leading cause of death of globally.

To this end, they designed a multipart study that included an analysis of fasting blood samples from 1,162 patients who had come into a cardiology center to be evaluated for heart disease.

The researchers were looking for common markers, or signs, in the patients’ blood that might reveal new risk factors.

The research resulted in the discovery of a substance in some of the blood samples that is only made when there is excess niacin.

That finding led to two additional “validation” studies, which included data from a total of 3,163 adults who either had heart disease or were suspected of having it.

The two investigations, one in the US and one in Europe, showed that the niacin breakdown product, 4PY, predicted participants’ future risk of heart attack, stroke and death.

Supplements in a hand

Researchers are advising people to 'avoid' niacin supplementation in light of the findings


The final part of the study involved experiments in mice. When the rodents were injected with 4PY, inflammation increased in their blood vessels.

Silver lining

The findings open a potential new avenue for interventions and therapeutics to reduce or prevent that inflammation, the researchers say.

"What's exciting about these results is that this pathway appears to be a previously unrecognized yet significant contributor to the development of cardiovascular disease," Dr Hazen said.

"What's more, we can measure it, meaning there is potential for diagnostic testing. These insights set the stage for developing new approaches to counteract the effects of this pathway."

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