For older adults with hardened arteries who are already taking statins to lower their bad cholesterol, adding a common supplement called niacin doesn’t make the plaque in their neck arteries shrink any more than statins alone—even though it raises their good cholesterol.

Niacin can raise good cholesterol in older heart patients, but even though it does that well, it doesn’t help shrink artery plaque any more than statins alone.

Even though adding a specific niacin pill to statins lowers bad cholesterol and raises good cholesterol in people with heart disease, it doesn’t actually help prevent heart attacks, strokes, or the need for heart procedures—so it’s not worth the extra pills.

For people with heart disease who are already taking statins, taking a special slow-release niacin pill plus another pill called laropiprant for about 4 years can slightly lower their bad cholesterol by 10 points and raise their good cholesterol by 6 points.

Niacin helps lower triglycerides more than statins alone in older heart patients, cutting them from 1.5 to 1.0 mmol/L, while statins alone only lower them a little.

Even without niacin, statins alone can shrink plaque in the neck arteries of older adults with heart disease, as long as their bad cholesterol is kept low.