Emerging potential benefits of modulating NAD+ metabolism in cardiovascular disease

Nicotinamide adenine dinucleotide (NAD(+)) and related metabolites are central mediators of fuel oxidation and bioenergetics within cardiomyocytes. Additionally, NAD(+) is required for the activity of multifunctional enzymes, including sirtuins and poly(ADP-ribose) polymerases that regulate posttranslational modifications, DNA damage responses, and Ca2+ signaling. Recent research has indicated that NAD(+) participates in a multitude of processes dysregulated in cardiovascular diseases. Therefore, supplementation of NAD(+) precursors, including nicotinamide riboside that boosts or repletes the NAD(+) metabolome, may be cardioprotective. This review examines the molecular physiology and preclinical data with respect to NAD(+) precursors in heart failure-related cardiac remodeling, ischemic-reperfusion injury, and arrhythmias. In addition, alternative NAD(+)-boosting strategies and potential systemic effects of NAD(+) supplementation with implications on cardiovascular health and disease are surveyed.