haha
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
If this is in fact true, my guess as to the reason would be that there are no drug reps pushing it, and little industry sponsored research doing the same, and no cushy positions and honoraria for investigators extolling niacin's wonders.Niacin has been taken in medicinal doses for 50 years or so. Although the possibility of liver damage is always mentioned with niacin, in fact, it seems to be very rare. As for flushing every piece of advice I have read from Mayo and elsewhere suggests that it is not harmful and I have never read even an anecdote that suggests otherwise. So, I am not worried about flushing. If new evidence were to appear I would reconsider. However, some people who take niacin stop taking it because they can't stand the flushing. So, it might indeed be a problem for you.
Niacin also has additional benefits that statins do not have, such as raising HDL and improving lipoprotein a. Parson's large study in the 70's with niacin had as its endpoint a 10% reduction in mortality. At the time of his book in the late 90's that was the only study of anti-cholesterol that showed a reduction of mortality rather than a reduction of cholesterol.
Because statins are newer drugs the extent of the side effects may still offer unpleasant surprises such as the research I referenced above that finds an incidence of muscle pain/weakness in 25% of statin users who also exercise. The muscle pain may last for years after stopping the statin. Further side effects of long term use may be shown in the future for all we know.
We manage cholesterol levels in the hope of reducing risk of serious illness in the future. So, it is a preventative, not a treatment for an actual illness that is present. In my own case the painful side effects of statin-induced myopathy turned out to be the more serious medical problem I have actually experienced as an adult, in terms of severity, duration, and unavailability of treatment. That is a pretty unfortunate outcome for a medicine that is only a preventative.
In my opinion given the effectiveness, lower risk profile and substantially lower cost of niacin, the appropriate question is why isn't it the first-line treatment for cholesteremia?
Ha