J Am Acad Dermatol. 2025 Oct 31:S0190-9622(25)03115-9. doi: 10.1016/j.jaad.2025.10.115. Online ahead of print.
ABSTRACT
BACKGROUND: Niacinamide is frequently used for non-melanoma skin cancer (NMSC) chemoprophylaxis. Recent studies raised concerns about cardiovascular risk associated with niacin metabolites.
OBJECTIVE: To evaluate the association between oral niacinamide use and cardiovascular outcomes in patients with multiple NMSCs.
METHODS: We conducted a retrospective cohort study using the TriNetX platform. Patients with ≥2 NMSCs or bullous pemphigoid who began taking oral niacinamide (≥500mg) were matched 1:1 with niacinamide-naïve controls. Outcomes included various major cardiovascular events.
RESULTS: After matching, each cohort consisted of 3,231 patients. Niacinamide use was associated with reduced risk of STEMI (RR: 0.547, 95% CI: 0.349-0.858, p=0.008), peripheral vascular disease (RR: 0.741, 95% CI: 0.605-0.909, p=0.004), and cardiac arrest (RR: 0.500, 95% CI: 0.275-0.909, p=0.020). Subgroup analyses by ASCVD history showed consistent cardiovascular benefits.
LIMITATIONS: As an observational study, causality cannot be established. The predominantly White study population and 3-year timeframe limit generalizability.
CONCLUSION: Niacinamide supplementation is associated with reductions in certain types of cardiovascular events, supporting its use in appropriate patient populations.
PMID:41177359 | DOI:10.1016/j.jaad.2025.10.115