Nicotinamide Riboside for Cardiovascular Disease
Nicotinamide riboside reliably raises NAD+ and appears safe, but the small human trials have not shown it meaningfully improves blood pressure, heart function, or any hard cardiovascular outcome. On current evidence it should not be relied on to prevent or treat cardiovascular disease.
Why this grade7-layer evidence engine
The grade is held to weak (C) because every human trial is small (n=24-94), short (6-12 weeks), and limited to surrogate markers such as blood pressure, arterial stiffness, and NAD+ levels; there are no trials measuring heart attack, stroke, or mortality. The 2018 pilot (PMID 29599478) raised NAD+ by roughly 60% but found no statistically significant whole-group effect on blood pressure or aortic stiffness, with the often-quoted ~8 mmHg systolic drop confined to an exploratory high-baseline subgroup.
Later trials reinforce the modest, inconsistent picture. A heart-failure trial (PMID 36644285) confirmed NR was safe and roughly doubled NAD+ but showed no improvement in walking distance, left-ventricular function, or quality of life. A 2025 trial (PMID 40770531) found NR plus exercise did not outperform exercise alone, even trending toward higher daytime blood pressure. The largest study (PMID 35620522, n=94) is only a protocol paper with no results and is part-funded by the manufacturer ChromaDex.
Authorities reflect this caution. The FDA and EFSA address only safety (GRAS status and an acceptable niacin source), not cardiovascular benefit, while the NHS and WHO take no position. Among clinicians, Harvard Health is openly skeptical, Cleveland Clinic is neutral, and major cardiology bodies do not recommend NR, leaving genuine but thin evidence that falls short of a stronger grade.
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditable▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.479
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 無高階證據可裁決
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status