While there are plenty of ways to lower bad cholesterol, very few proven drugs/supplements exist to raise good cholesterol. Even if niacin does elevate homocysteine, it can also normalize blood sugar, greatly increase blood flow, and increase HGH (in absence of food, but especially lipids.) Homocysteine could potentially make blood platelets stickier and reduce blood flow, but niacin has the ability to increase blood flow, especially in smaller capillaries. As such, niacin could also greatly help in detoxifying fatty tissue. These are all super beneficial things. As always, we must always weigh the benefits as well as the risks. This was the crux of my well-meaning contention.
In posting here, I try and remain realistic and realize not everyone reading our words will exercise, or have proper nutrition, or have as an informed, participatory, or understanding a doctor. And I know things like saturated fats, or even TMG (Betaine) - for that matter - can raise total blood lipids. Therefore, many doctors will then demand their patients take statins who haven't at least tried the alternatives. I want to make sure my messages direct them to the safe alternatives, and away from a potential life-time of statins.
I agree with you about not jumping through hoops though. And I was lucky enough to find a doctor who would allow limits to be set for my mom. We were able to reach a consensus that anything at or above 240 total cholesterol would be our threshold. Let's face it, as we age not only do our cholesterol levels rise, but homocysteine also rises, and our hormone levels drop.
Of course, if someone takes niacin and experiences super high homocysteine levels, there are other alternatives. Although, I might recommend taking B6 supplementation right along with niacin at first. B6 can normalize niacin without lowering the hypolipidemic effect -- unlike inositol's effect on B3, it seems, in a fair majority of people. B6 and B3 can act synergistically, much in the way that B6 can greatly enhance the effectiveness of Folic Acid. By the way, just as easily as B3 can deplete levels of B6 and B12, so can B6 and B12 deplete levels of Folic Acid.
In fact, many B Vitamins taken in high doses have the potential to deplete one another.
Invest in a copy of Dr. Thomas Levy's book, "Stop America's #1 Killer" and you can put all this cholesterol/heart disease nonsense to rest.