Analysis: Nicotinamide Not Linked to Elevated MACE Risk

Results from a new retrospective cohort study suggest nicotinamide exposure was not associated with an increased risk of major adverse cardiovascular events (MACE).

The analysis included data from 13,108 patients in the Vanderbilt University Medical Center (VUMC) and the Million Veteran Program (MVP). The researchers investigate whether nicotinamide use could elevate the risk of MACE. The study collected between January 1989 and February 2024, with analysis performed from March to December 2024. Cohort characteristics revealed the study population was predominantly male (91%) with a mean age of 66.8 years. The researchers also balanced for key demographic variables (age, sex, race, and ethnicity). Of the 13,108 patients included, 5,291 were exposed to nicotinamide. In the VUMC cohort, 1,228 patients were exposed to nicotinamide vs. 253 unexposed; in the MVP cohort, 4,063 were exposed vs. 7,564 unexposed.

There was no significant difference in the primary study endpoint (the cumulative incidence of MACE) between nicotinamide-exposed and unexposed cohorts. Stratified hazard models adjusted for prior MACE history confirmed no meaningful association between nicotinamide exposure and the risk of subsequent MACE. For patients with no prior MACE, hazard ratios were 2.02 (VUMC) and 1.07 (MVP); for prior MACE, 0.46 (VUMC) and 1.04 (MVP).

"Nicotinamide exposure was not associated with increased risk of MACE," the authors wrote. "Rather, patients with prior MACE were likely to develop subsequent MACE."

Source: Wheless L, et al. JAMA Dermatology. 2025. Doi:10.1001/jamadermatol.2025.0001