Does Nicotinamide Increase Heart Disease Risk? A New Study

Study Finds No Major Cardiovascular Risk From Nicotinamide

Nicotinamide, a form of vitamin B3, is widely known for its role in dermatology, particularly in reducing the risk of skin cancer, such as non-melanoma skin cancer. While it has gained popularity due to its beneficial effects on skin health, there have been growing concerns about its potential cardiovascular risks, especially regarding the possibility of major adverse cardiovascular events (MACE). A new large-scale retrospective cohort study aimed to address these concerns by investigating the relationship between nicotinamide exposure and the risk of cardiovascular events. The study's findings have provided reassurance, showing no significant increase in MACE risk among individuals exposed to nicotinamide.

Study Design and Methodology

The study analyzed data from two extensive cohorts: the Vanderbilt University Medical Center (VUMC) and the Million Veteran Program (MVP), encompassing a total of 13,108 patients, with a mean age of 66.8 years, 91% of whom were male. The observation period spanned from January 1989 to February 2024, providing an extensive dataset. Out of the total participants, 5,291 had confirmed exposure to nicotinamide. The primary objective of this study was to evaluate whether exposure to nicotinamide was linked to an increased risk of MACE, which includes events such as heart attack, stroke, and other serious cardiovascular conditions.

Key Findings

The study found no significant association between nicotinamide exposure and an increased risk of MACE, regardless of the patient's previous cardiovascular history. In the VUMC cohort, participants who were exposed to nicotinamide had similar MACE risk to those who were not exposed. This was true for individuals with no history of MACE (cause-specific hazard ratio [HR], 2.02; 95% CI, 0.81-5.05) as well as those with a prior MACE history (HR, 0.46; 95% CI, 0.22-0.95).

Similarly, the MVP cohort showed no significant association between nicotinamide exposure and MACE, regardless of prior cardiovascular events. In this cohort, the hazard ratios for individuals without prior MACE were 1.07 (95% CI, 0.75-1.17), and for those with prior MACE, it was 1.04 (95% CI, 0.53-2.06). Moreover, in the MVP cohort, there were no differences in the cumulative incidence of MACE among participants with varying levels of nicotinamide exposure (low, medium, or high) who had no history of MACE.

A critical finding in both cohorts was the strong association between prior MACE and the likelihood of subsequent MACE. In the VUMC cohort, individuals with a history of MACE had a significantly higher risk of experiencing future MACE (HR, 10.29; 95% CI, 6.70-15.80), while the MVP cohort also demonstrated a strong correlation (HR, 2.90; 95% CI, 2.21-3.81).

Implications for Clinical Practice

These findings provide valuable information for clinicians, particularly in reassuring them about the cardiovascular safety of nicotinamide. Despite some methodological limitations—such as potential misclassification bias, cohort heterogeneity, and the overrepresentation of male participants—this large cohort study suggests that nicotinamide does not significantly increase the risk of MACE.

For clinicians treating patients with a history of skin cancer, this data should alleviate concerns regarding the cardiovascular risks of using nicotinamide for skin cancer prevention. As always, clinicians must assess individual patient risks and provide personalized care, but the evidence suggests that nicotinamide remains a safe and effective option for reducing skin cancer risk without substantially increasing the risk of cardiovascular events.

Limitations of the Study

Although the study provides significant insights, there are limitations worth noting. The retrospective design of the study means that causality cannot be definitively established, and there is potential for misclassification bias. Additionally, the majority of participants were male, which may limit the generalizability of the findings to female populations. The heterogeneity within the cohort and the observational nature of the study also present challenges in drawing definitive conclusions.

Study Reference: https://jamanetwork.com/journals/jamadermatology/article-abstract/2830414

Conclusion

In conclusion, the study provides reassuring evidence that nicotinamide does not appear to increase the risk of major adverse cardiovascular events, even in individuals with a history of cardiovascular disease. As a result, clinicians can continue to use nicotinamide for its dermatologic benefits without significant concern for cardiovascular harm. However, as always, it’s crucial for healthcare providers to consider the individual health status of their patients when making treatment decisions.