Current opinion in cardiologyApr 28, 2026

The role of NAD in heart and blood vessel disease

Longevity & Aging Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 29, 2026

Abstract

An imbalance in the NAD+/NADH ratio caused by NAD+ depletion is implicated in various diseases, including cardiovascular diseases and heart failure.

NAD+ plays a crucial role in energy metabolism and is important for cardiovascular health.
Activation of the enzyme nicotinamide phosphoribosyltransferase (NAMPT) may help replenish NAD+ levels.
Decreased cellular NAD+ content in heart cells is associated with mitochondrial dysfunction and increased oxidative stress.
NAD+ depletion may lead to increased cell death in cardiomyocytes.
Clinical trials are evaluating NAD+ supplementation and its precursors as potential therapies for cardiovascular diseases.

Simplified

PURPOSE OF REVIEW: The nicotinamide adenine dinucleotide (NAD+) is an important redox cofactor that plays a major role in energy metabolism. This review provides an overview of the current understanding of NAD+ in cardiovascular diseases.

RECENT FINDINGS: Activation of the rate-limiting enzyme nicotinamide phosphoribosyltransferase (NAMPT), a key component of the NAD+ salvage pathway, is emerging as an alternative method to replenish the cycling NAD+ pools and to alleviate the cardiovascular pathophysiology driven by NAD+ depletion. The NAD+-dependent sirtuins play an important role in cellular metabolism and integrate the circadian signaling of clock controlled Nampt oscillation and thereby NAD+ synthesis.

SUMMARY: An imbalance in the NAD+/NADH ratio caused by NAD+ depletion is implicated in various diseases, including metabolic disease, aging, and cancer. The cellular NAD+ content is decreased in cardiovascular diseases and heart failure. Lack of NAD+ in cardiomyocytes leads to mitochondrial dysfunction, increased reactive oxygen species (ROS) production and cell death. The supplementation of NAD+ and its precursors such as nicotinic acid (NA), nicotinamide (NAM), nicotinamide mononucleotide (NMN), and nicotinamide riboside (NR) are currently being evaluated in clinical trials. This review mainly focuses on the role of NAD+ in cardiovascular diseases and therapeutics.

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The role of NAD in heart and blood vessel disease

Abstract

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