Decreased risk of cardiovascular disease in dermatology patients taking niacinamide: A TriNetX cohort study.

Abstract

Niacinamide is frequently used for nonmelanoma skin cancer (NMSC) chemoprophylaxis. Recent studies raised concerns about cardiovascular risk associated with niacin metabolites. To evaluate the association between oral niacinamide use and cardiovascular outcomes in patients with multiple NMSCs. We conducted a retrospective cohort study using the TriNetX platform. Patients with ≥ 2 NMSCs or bullous pemphigoid who began taking oral niacinamide (≥ 500 mg) were matched 1:1 with niacinamide-naive controls. Outcomes included various major cardiovascular events. After matching, each cohort consisted of 3231 patients. Niacinamide use was associated with reduced risk of ST elevation myocardial infarction (risk ratio [RR]: 0.547, 95% confidence interval [CI]: 0.349-0.858, P = .008), peripheral vascular disease (RR: 0.741, 95% CI: 0.605-0.909, P = .004), and cardiac arrest (RR: 0.500, 95% CI: 0.275-0.909, P = .020). Subgroup analyses by atherosclerotic cardiovascular disease history showed consistent cardiovascular benefits. As an observational study, causality cannot be established. The predominantly White study population and 3-year timeframe limit generalizability. Niacinamide supplementation is associated with reductions in certain types of cardiovascular events, supporting its use in appropriate patient populations.