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Cardiovascular safety of vitamin B3 administration

Nature Medicine volume 30, pages 2446–2447 (2024)Cite this article

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Matters Arising to this article was published on 05 September 2024

The Original Article was published on 19 February 2024

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arising from M. Ferrell et al. Nature Medicine https://doi.org/10.1038/s41591-023-02793-8 (2024)

Ferrell et al.1 recently reported associations between serum levels of the terminal niacin metabolites N1-methyl-2-pyridone-5-carboxamide (2PY) and N1-methyl-4-pyridone-3-carboxamide (4PY) with an increased 3-year incident risk of major adverse cardiovascular events. The association of 4PY with cardiovascular risk was linked to increased endothelial VCAM-1 expression and increased leukocyte adherence to the vascular endothelium as a potential causal mechanism. The study suggests that niacin supplementation may be harmful by increasing cardiovascular morbidity and mortality. Strikingly, the exact mechanism identified as a potential adverse outcome by Ferrell et al.1 has been noted to be suppressed with niacin supplementation2, arguing for a more complex interpretation of the findings. Here, we would like to briefly put the study of Ferrell et al.1 into the perspective of decades of clinical trial experience and pharmacovigilance with nicotinic acid (niacin) and nicotinamide, the two forms of vitamin B3.

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Authors and Affiliations

  1. Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany

    Stefan Schreiber & Matthias Laudes

  2. Institute of Clinical Molecular Biology, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany

    Stefan Schreiber, Georg H. Waetzig & Philip Rosenstiel

  3. CONARIS Research Institute AG, Kiel, Germany

    Georg H. Waetzig

  4. Institute of Diabetes and Clinical Metabolism Research, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany

    Matthias Laudes

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  1. Stefan Schreiber
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  2. Georg H. Waetzig
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Contributions

S.S., G.H.W., M.L. and P.R. contributed to drafting and reviewing the paper.

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Correspondence to Stefan Schreiber.

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Competing interests

S.S. reports indirect stock ownership in Gerion Biotech as well as consulting and personal fees from AbbVie, Allergosan, Amgen, Arena, BMS, Biogen, Celltrion, Celgene, Falk, Ferring, Fresenius, Galapagos/Gilead, HIKMA, I-Mab, Janssen, Lilly, Morphic, MSD, Mylan, Pfizer, Prometheus, Protagonist, Provention Bio, Sandoz/Hexal, Takeda and Theravance. G.H.W. is in part-time employment by CONARIS Research Institute AG (Kiel, Germany). M.L. reports lecture fees from Amarin, AstraZeneca, Boehringer Ingelheim, Chiesi, HRA Pharma, Lilly, Novo Nordisk, Roche and Sanofi. P.R. reports stock ownership in Gerion Biotech and consulting fees from Takeda.

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Schreiber, S., Waetzig, G.H., Laudes, M. et al. Cardiovascular safety of vitamin B3 administration. Nat Med 30, 2446–2447 (2024). https://doi.org/10.1038/s41591-024-03219-9

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