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- A breakdown product of excess niacin was linked to an increased risk of cardiovascular events such as heart attacks and strokes.
- Niacin, or vitamin B3, is necessary for a healthy nervous system. Most people get enough of it in their diet.
- Breads, flours and other foods are fortified with niacin. However, researchers say this may need to be reconsidered, given the new findings.
For decades, the U.S. food industry has added niacin (also known as vitamin B3) to bread, flour, and corn products to prevent pellagraa disease caused by a deficiency of this nutrient.
The program was so successful that today pellagra is virtually unknown in the country, except among certain populations with extreme food insecurity.
While preventing deficiency is a good thing, a new study published February 19 in
In the study, researchers looked specifically at a metabolic byproduct of excess niacin known as 4PY.
The researchers did not set out to examine the role of niacin in cardiovascular disease. Instead, they were trying to identify why when people are treated for other risk factors, such as diabetes and high cholesterol — some still have cardiovascular events.
In their initial research, 4PY, whose full name is N1-methyl-4-pyridone-3-carboxamide, was shown as a possible blood marker of cardiovascular risk. The researchers then traced this compound to excess niacin.
They found that participants in the highest quarter of 4PY levels had about twice the risk of major adverse cardiovascular events, such as a heart attack or stroke, compared to those in the lowest quarter.
To put it another way: “one in four people in our cohorts had high levels of 4PY and are at significantly increased risk of adverse cardiovascular events,” the study author said. Dr. Stanley Hazenhe told Healthline.
Researchers maintain that 4PY increases cardiovascular risk through inflammation of blood vessels, known as vascular inflammation.
The ability of niacin to reduce low-density lipoprotein (LDL or “bad”) cholesterol and triglyceridesand increasing high-density lipoprotein (HDL or “good”) cholesterol led to it being used as a treatment to prevent cardiovascular disease before the development of cholesterol-lowering statins.
However, some research shows that taking niacin does not reduce the risk of cardiovascular disease events, or offers no additional benefit when used together with statins. One study It was even found that niacin use may slightly increase the risk of premature death.
In addition to this, the new study’s findings suggest that excess niacin may counteract some of the benefits of smaller amounts of niacin, such as
“While niacin was previously prescribed as a cholesterol-lowering medication, its use has fallen out of favor as multiple studies did not find as much benefit to cardiovascular health as initially thought,” he said. Dr. Cheng-Han Cheninterventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California.
Chen was not involved in the study.
“This [new] The study will put another nail in the coffin of niacin use in heart disease,” he told Healthline.
However, Chen cautions that more research is needed to understand the relationship between different amounts of excess niacin and cardiovascular disease, especially in people who take niacin supplements.
To avoid a deficiency, adults need
By comparison, therapeutic levels of niacin, such as the amounts used in clinical trials to lower cholesterol, range between 1,500 and 2,500 milligrams per day, the researchers write.
People taking prescription or over-the-counter niacin products were excluded from the analysis, Hazen said. That leaves diet as the main source of niacin for participants.
The researchers did not have data on how much niacin the participants consumed in their diet. However, Hazen noted that ingesting excessive amounts of niacin (or related compounds such as nicotinamide adenine dinucleotide, nicotinic acid and nicotinamide riboside – have all been previously shown to increase the level of 4PY, as well as another decay product, 2PY.
In this study, 2PY, also known as N1-methyl-2-pyridone-5-carboxamide, was not associated with inflammation or an increased risk of cardiovascular disease.
Americans tend to consume more than enough niacin to prevent a deficiency, ingesting an average of 37 milligrams per day of niacin, according to the National Health and Nutrition Examination Surveys (NHANES) 2017-2020. Additionally, that survey shows that less than 4% of adults report consuming less than 15 milligrams per day, the authors note.
Therefore, most Americans get enough niacin in their diet, some of which comes from enriched foodswhich Hazen believes may need to be reconsidered in light of the new findings.
“The bottom line is not that we should completely eliminate our niacin intake; that’s not a realistic approach,” he said in a statement. release. “Given these findings, a debate over whether a continued mandate for niacin fortification of flours and cereals could be warranted in the United States.”
Chen warns against people routinely taking niacin supplements, especially if they have a higher risk of cardiovascular disease. If you are considering taking niacin or related products, you should talk to your doctor first.
“However, it may be more difficult to avoid foods enriched with niacin, given its ubiquity in the food chain,” he said. Therefore, “niacin fortification may need to be examined at a higher level as a matter of public policy.”
The researchers found that people with higher amounts of an excess breakdown product of niacin had a higher risk of major adverse cardiovascular events, such as heart attacks and strokes.
This breakdown product, known as 4PY, acts through inflammation of blood vessels to increase cardiovascular risk, researchers say.
More research is needed to understand the link between different levels of excess niacin and the risk of cardiovascular disease. Researchers call for reexamining food fortification with niacin.
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