A NEW study examining the relationship between niacinamide, also known as nicotinamide, exposure and major adverse cardiovascular events (MACE), researchers found no evidence of increased risk. Instead, patients with a history of MACE were more likely to experience subsequent events.
The study utilised retrospective data from two cohorts: Vanderbilt University Medical Center (VUMC) and the Million Veteran Program (MVP), encompassing 13,108 patients. Participants were categorised based on documented nicotinamide use or recommendation for use. The VUMC cohort included 1,228 exposed and 253 unexposed patients, while the MVP cohort had 4,063 exposed and 7,564 unexposed individuals. Propensity score matching was employed in the MVP cohort to account for baseline differences. The primary outcome was the incidence of MACE, determined using a validated phenotype. Statistical models adjusted for prior MACE revealed no significant association between nicotinamide exposure and MACE risk in either cohort. For instance, in the VUMC cohort, hazard ratios (HR) were 2.02 (95% CI, 0.81–5.05) for those without prior MACE and 0.46 (95% CI, 0.22–0.95) for those with prior MACE.
The findings suggest that nicotinamide does not increase MACE risk in real-world settings, providing reassurance to clinicians prescribing it for various conditions. However, patients with a history of MACE remain at higher risk of subsequent events regardless of nicotinamide use. Future research should explore potential long-term effects and mechanisms underlying these observations to guide clinical practice further.
Katrina Thornber, EMJ
Reference
Wheless L et al. Risk of Major Adverse Cardiovascular Events Following Nicotinamide Exposure. JAMA Dermatol. 2025;DOI:10.1001/jamadermatol.2025.0001.
