TOPLINE:

In patients with nonmelanoma skin cancer (NMSC) or bullous pemphigoid, oral niacinamide was associated with a 45% lower risk for ST-elevation myocardial infarction (STEMI) and a 26% lower risk for peripheral vascular disease than niacinamide-naive individuals.

METHODOLOGY:

• To address concerns about the CV risk associated with niacin metabolites, researchers conducted a retrospective cohort study of 3231 patients with at least two NMSCs or bullous pemphigoid who initiated oral niacinamide ≥ 500 mg for prevention of NMSC, from the TriNetX network database and 3231 niacinamide-naive individuals.
• The mean age was 71.6 years; 58.8% were men, and 87.8% were White individuals.
• The primary outcome were adverse CV events, including STEMI, non-STEMI (NSTEMI), stroke, transient ischemic attack, peripheral vascular disease, all acute coronary syndrome types, and cardiac arrest.
• The median follow-up duration was 912 days for the niacinamide group and 1095 days for control individuals.

TAKEAWAY:

• Niacinamide users vs control individuals had a significantly lower risk for STEMI (0.9% vs 1.6%; risk ratio [RR], 0.547; P = .008) and peripheral vascular disease (4.7% vs 6.3%; RR, 0.741; P = .004). Niacinamide users vs control individuals also had a lower risk for cardiac arrest (0.5% vs 1.0), but this was not statistically significant.
• No significant differences were seen in NSTEMI, type 2 myocardial infarction, stroke, transient ischemic attack, or acute coronary syndrome.
• Among patients with a history of atherosclerotic CV disease, niacinamide significantly reduced the risk for STEMI (RR, 0.492; P = .001), peripheral vascular disease (RR, 0.769; P = .009), acute coronary syndrome (RR, 0.754; P = .012), and cardiac arrest (RR, 0.406; P = .004).
• In patients without atherosclerotic CV disease, significant reductions were observed in strokes with niacinamide use (RR, 0.432; P = .002), transient ischemic attack (RR, 0.429; P = .005), and all acute coronary syndrome types (RR, 0.451; P = .001).

IN PRACTICE:

“Niacinamide supplementation is associated with significant reductions in atherosclerotic cardiovascular events,” the authors concluded, adding that these “reassuring findings support its continued use for NMSC chemoprophylaxis.” They added that if more research “lends credence to niacinamide for cardioprotection, increased adoption in cardiac patients may secondarily confer a chemoprophylactic effect for NMSC in a larger population.”

SOURCE:

The study was led by Yousef Salem, MD, Division of Dermatology, University of Texas at Austin Dell Medical School, and was published online on October 31 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The study was limited by its retrospective design, residual confounding, predominantly White population, and short-term follow-up.

DISCLOSURES:

The authors did not report any funding information or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.