Would you consider adding niacin to the lipid lowering regimen in statin-intolerant patients who cannot afford PCSK9i or bempedoic acid?  

Yes, in a patient who absolutely cannot take a statin or other common alternatives such as ezetimibe, PCSK9 inhibitors, or Bempedoic acid, Niacin for ASCVD risk reduction is still a reasonable choice. While the combination of statin and niacin has been shown to be unhelpful (and possibly of greater ...

I agree with Dr. @Simha that niacin can be used, but I feel that this would be under very rare conditions. Most patients are not truly statin intolerant and it is important to trial several different statins, including very low doses, before concluding a patient is statin intolerant. Moreover, ezeti...

This question comes up often in patients with high Lp(a), and not for general hyperlipidemia, so I will direct my comments towards that: niacin was not shown to reduce risk or offer clinical benefit despite a reduction in Lp(a) level, and a recent study has suggested contribution to cardiovascular d...

Niacin has not been shown to reduce CV risk and therefore should not be used for that purpose.

Agree that low-dose statins eg rosuvastatin 5 mg twice a week usually are well tolerated. Can also slowly increase if tolerated.

Niacin is complicated. I am not going to argue for its widespread use, but I do think it deserves clinical consideration and, especially, further research. I apologize for the length of this note, but it's a fascinating story.Niacin showed good results in early clinical trials. Because niacin itself...