How does Niacin lower LP(a)?

Niacin can lower lipoprotein(a), often referred to as LP(a), by up to 25%, but the exact mechanism behind this effect remains unclear. According to Dr. Ron Krauss, while it's evident that Niacin can lower both LP(a) and small LDL particles, which are risk factors for atherosclerotic disease, the specific pathway through which Niacin acts to reduce LP(a) is not well understood. It may possibly involve the VLDL pathway, but this has not been definitively established 1.

Additionally, despite Niacin's ability to lower LP(a), its effectiveness and safety for long-term cardiovascular outcomes is debated. Notably, large cardiovascular outcome studies to confirm the benefits of Niacin therapy are lacking. This absence of robust data, coupled with potential side effects like flushing, has led to a reduction in its prescription 2.