An extensive research on niacin, a popular drug for cholesterol therapy, says that it increases the risk of death and is not good in avoiding heart attacks or strokes.

Niacin gained in popularity in the last 50 years for its effectiveness in raising "good" high-density lipoprotein cholesterol levels.

The new research stated that niacin was associated with significant increase in serious side effects such as liver problems, excess infections, excess bleeding, gout, high blood sugar for diabetics and the onset of diabetes in people who did not have it during the start of the study.

"There might be one excess death for every 200 people we put on niacin. With that kind of signal, this is an unacceptable therapy for the vast majority of patients," Dr Donald Lloyd-Jones, chair of preventive medicine at Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, said in a press release. He also warned that niacin should not be prescribed to most of the patients.

The study was conducted on adults, aged between 50 and 80, with cardiovascular disease who took extended-release niacin (vitamin B3) and laropiprant (a drug that reduces face flushing caused by high doses of niacin). Researchers wanted to see if the drug reduced heart attack and stroke risk. This was compared to a  placebo dose over four years. All patients in the trial were already being treated with statin medication.

"For the reduction of heart disease and stroke risk, statins remain the most important drug-based strategy by far because of their demonstrated benefit and their good safety profile," said Dr. Lloyd-Jones, who was a member of the task force that rewrote cholesterol treatment guidelines in 2013 for the American College of Cardiology and the American Heart Association.

According to Dr.  Lloyd-Jones, niacin should be prescribed only for patients with extremely high risk for a heart attack and stroke who cannot take statins and for whom there are no other evidence-based options.

The findings indicate that higher HDL levels are a sign of lowered risk for heart attacks and stroke. Increasing HDL levels with niacin does not appear to impact cardiovascular outcomes nor does lowering triglyceride levels.

"The recent niacin clinical trials offer important new evidence that raising 'good' cholesterol (HDL) levels on top of statin therapy does not have the positive outcome that had been hoped for," said Neil Stone, M.D., the Robert Bonow MD Professor in Cardiology at Feinberg and a cardiologist at Northwestern Memorial Hospital. "Lowering 'bad' cholesterol (LDL) with an optimal intensity of tolerated statins and adherence to healthy lifestyle changes remains the most effective approach to prevent strokes and heart attacks for patients at risk of cardiovascular disease."

The review was published in the New England Journal of Medicine.