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Niacin, food intake and cardiovascular effects

Nature Medicine volume 30, pages 2444–2445 (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

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

Ferrell et al.1 report a surprisingly strong association between terminal metabolites of niacin and major adverse cardiovascular events (MACE), amounting to roughly a doubling of MACE risk in the 4th quartile of circulating levels of the 4PY (N1-methyl-4-pyridone-3-carboxamide) metabolite. The results presented by Ferrell et al.1 are impressive and deserve further attention. Here we would like to suggest alternative interpretations for these results; in particular, we discuss how two aspects of food intake—first, consumption of foods with high niacin content and, second, a historical shift from mealtime to bedtime administration of pharmacological niacin doses—could help explain cardiovascular effects ascribed to niacin.

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Authors and Affiliations

  1. Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    John R. Guyton

  2. Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA

    William E. Boden

  3. VA Boston Healthcare System and the Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA

    William E. Boden

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  1. John R. Guyton
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  2. William E. Boden
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Contributions

J.R.G. wrote the initial draft. W.E.B. and J.R.G. together formulated arguments, interpreted available evidence and revised the manuscript.

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Correspondence to John R. Guyton.

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Competing interests

J.R.G. declares no competing interests. W.E.B. served on the executive steering committee for the TRAVERSE trial, funded by AbbVie, and has received research grant support from AbbVie. In the past, both authors received institutional support from the AIM-HIGH trial funded by the US National Institutes of Health (NIH), and W.E.B. served as principal investigator of AIM-HIGH.

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Guyton, J.R., Boden, W.E. Niacin, food intake and cardiovascular effects. Nat Med 30, 2444–2445 (2024). https://doi.org/10.1038/s41591-024-03220-2

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