Excess 4PY triggers vascular inflammation
Scientists also found that 4PY directly triggers vascular inflammation, which can damage blood vessels and lead to a buildup of plaque on artery walls, known as atherosclerosis.
“Atherosclerosis is caused by both high cholesterol and inflammation. We know how to treat the high cholesterol side of the equation, but not the inflammation side. This pathway appears to be a major participant in vascular inflammation,” Dr. Hazen said.
“(Our) research uncovered that excess niacin fuels inflammation (and) cardiovascular disease through a newly discovered pathway. (These) findings are significant because they provide a foundation for potential new interventions and therapeutics to reduce or prevent inflammation.”
— Dr. Stanley Hazen
Dr. Hazen said that now with the discovery of this link, there is much more research to do.
“On the one hand, we need to explore what other cardiovascular diseases/phenotypes are linked to 4PY since vascular inflammation is a fundamental contributor to many diseases/phenotypes — e.g. heart failure, stroke, (and) other forms of vascular disease,” he explained.
“Beyond this, we then want to focus on how to disrupt this pathway to leverage the newly gained knowledge to develop a therapeutic,” he added.
Should I stop using niacin supplements?
MNT also spoke with Dr. Cheng-Han Chen, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, about this study.
“This study identifies excess niacin, specifically its breakdown metabolite 4PY, as a risk factor for major adverse cardiovascular events such as heart attack and stroke,” Dr. Chen explained.
“While niacin was previously prescribed as a cholesterol-lowering medicationTrusted Source, its use has fallen out of favor as multiple studies did not find as much benefit to cardiovascular health as initially thought. This study will put another nail in the coffin for the use of niacin in heart disease.”
— Dr. Cheng-Han Chen
Meanwhile, Dr. Charles Brenner, Ph.D., Alfred E. Mann Chair in Diabetes and Cancer Metabolism, and cardiovascular expert with a special interest in NAD+, pointed out to MNT that this was an observational study that only assessed associations and did not determine causality.
“In other words, this was not a randomized, controlled intervention study (niacin or other B3 was not administered), so no conclusions of cause and effect can be drawn from it. Further, it inappropriately links common B vitamins and other NAD+ precursors to heart disease and omits key contextual information,” he said.
Dr. Brenner said the study results are contradicted by previous research showing that other forms of niacin, such as NR, may not increase the risk for cardiovascular disease and/or increase inflammation.
Dr. Chen said more studies need to be performed to better understand the dose relationship between niacin supplementation and cardiovascular disease.
“For now, I would caution against routine intake of niacin supplements in the average person,” he continued. “It may be more difficult, however, to avoid niacin-fortified foods given its ubiquity in the food chain; niacin fortification may need to be examined at a higher level as a matter of public policy.”
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