Too much niacin increases the risk of cardiovascular disease

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Even without classic risk factors such as high blood pressure, some people may h
Even without classic risk factors such as high blood pressure, some people may have an increased risk of cardiovascular disease. Researchers have identified an unexpected factor for this. RUB, Marquard

Too much niacin increases the risk of cardiovascular disease

Niacin, also known as vitamin B3, is freely available as a dietary supplement.

Why do some people have an increased risk of heart attack and stroke even without classic risk factors such as high cholesterol? An international research team has taken an open-ended look at what circulates in the bloodstream of affected people and distinguishes them from others. The researchers discovered metabolic end products of excess niacin. "They increase the risk of cardiovascular disease via an inflammatory mechanism," says Arash Haghikia, Director of the Department of Cardiology at St. Josef Hospital, University Hospital of Ruhr University Bochum, who was involved in the work during his time at CharitÚ, Universitńtsmedizin Berlin. The researchers from the USA and Germany report in the journal Nature Medicine from February 19, 2024 .

In search of undiscovered risk factors

To find out which previously undiscovered risk factors could play a role in cardiovascular disease, the research team analyzed blood samples from over 1,000 patients who had heart disease. They were looking for small molecules whose levels could predict the likelihood of cardiovascular disease independent of traditional risk factors. Two molecules were particularly conspicuous. Further analysis revealed that these were the substances 2PY and 4PY: both metabolic end products of excess niacin.

Niacin is an important nutrient also known as vitamin B3. Adults should consume around 15 milligrams per day. A balanced diet provides sufficient amounts. However, as many Americans suffered from life-threatening deficiency symptoms during the Great Depression in the first half of the 20th century, niacin has been added to flour and cereal products ever since and is still added today. This has led to an oversupply in the population as a result of today’s standard diet. In addition, niacin and other substances that are metabolized in the body to produce the same degradation products are freely available as anti-ageing food supplements.


Connections are complex

The researchers investigated the connection further and found that the path from high 2PY and 4PY levels to an increased risk of cardiovascular disease runs via inflammatory processes in the blood vessels.

"Paradoxically, niacin can lower cholesterol levels and has been tested as a cholesterol-lowering agent in clinical trials in the past, but did not lead to a reduction in the risk of cardiovascular disease as expected," explains Arash Haghikia. "The relationships are therefore complex, and our findings fit in well with this paradox."

Marc Ferell et al: A Terminal Metabolite of Niacin Promotes Vascular Inflammation and Contributes to Cardiovascular Disease Risk, in: Nature Medicine, 2024, DOI: 10.1038/s41591’023 -02793-8