Niagen (Nicotinamide Riboside) for Cardiovascular Health
Niagen (nicotinamide riboside) is not recommended for cardiovascular health as there is no evidence supporting its efficacy for heart disease prevention or treatment in current clinical guidelines.
Current Evidence on Niacin and Cardiovascular Health
Understanding Niacin vs. Nicotinamide Riboside
While the question asks about Niagen (nicotinamide riboside), it's important to clarify that this compound is different from niacin (nicotinic acid), which has been extensively studied for cardiovascular effects:
- Niacin (nicotinic acid) is a form of vitamin B3 that has been used in cardiovascular medicine
- Nicotinamide riboside (Niagen) is a newer NAD+ precursor without established cardiovascular benefits
- Current cardiovascular guidelines do not mention nicotinamide riboside for heart health
Evidence on Traditional Niacin (Not Niagen)
Major cardiovascular guidelines have evaluated traditional niacin (not nicotinamide riboside) and found:
- Niacin therapy does not reduce mortality, cardiovascular mortality, or non-cardiovascular mortality 1
- Recent large trials have shown no benefit when niacin was added to statin therapy 2
- The AHA/ACC guidelines no longer recommend niacin for routine cardiovascular risk reduction 2
Key Clinical Trials on Niacin
Two major trials challenged previous assumptions about niacin's benefits:
- The HPS2-THRIVE trial found no significant difference in coronary death, MI, stroke, or coronary revascularization when adding niacin-laropiprant to statin therapy (13.2% vs. 13.7%) 2
- Niacin therapy was associated with increased side effects including new-onset diabetes, gastrointestinal issues, musculoskeletal problems, skin reactions, and unexpectedly, infection and bleeding 2
Current Guideline Recommendations
Primary Prevention
For primary prevention of cardiovascular disease, current guidelines recommend:
- Statins as the primary lipid-lowering therapy for those at elevated risk 2
- Lifestyle modifications including diet, exercise, and weight management 2
- Blood pressure control and management of other risk factors 2
Secondary Prevention
For those with established cardiovascular disease:
- Statins remain the cornerstone of lipid management 2
- Ezetimibe or PCSK9 inhibitors may be added for additional LDL-C lowering 2
- For elevated triglycerides, icosapent ethyl may be considered in some patients 2
Why Niacin Has Fallen Out of Favor
Despite historical use, niacin is no longer recommended because:
- Cochrane review found niacin does not reduce overall mortality (RR 1.05,95% CI 0.97 to 1.12) 1
- No significant reduction in cardiovascular mortality (RR 1.02,95% CI 0.93 to 1.12) 1
- Patients on niacin were more likely to discontinue treatment due to side effects (RR 2.17,95% CI 1.70 to 2.77) 1
- Combination of statin plus niacin has not been shown to improve outcomes above statin therapy alone 2
Practical Recommendations
For patients seeking to improve cardiovascular health:
Focus on established preventive strategies:
- Regular physical activity
- Heart-healthy diet
- Weight management
- Blood pressure control
- Smoking cessation
For lipid management, follow evidence-based approaches:
- Statins for those at elevated risk
- Non-statin therapies like ezetimibe or PCSK9 inhibitors when indicated
- Management of other risk factors
Avoid unproven supplements like Niagen for cardiovascular health, as they lack supporting evidence and may divert attention from proven therapies.
Common Pitfalls to Avoid
- Assuming all forms of vitamin B3 have similar cardiovascular effects
- Relying on supplements without established clinical benefit
- Substituting unproven therapies for evidence-based treatments
- Using over-the-counter niacin products without medical supervision (which can cause serious side effects)
- Delaying proven therapies while trying alternative approaches
In conclusion, while research on nicotinamide riboside continues, there is currently insufficient evidence to recommend Niagen for cardiovascular health improvement or disease prevention.