Cleveland Clinic researchers have identified a new pathway that contributes to cardiovascular disease associated with high levels of niacin, a common B vitamin previously recommended to lower cholesterol.

The team, led by Stanley Hazen, MD, PhD, discovered a link between 4PY, a breakdown product of excess niacin, and heart disease. Higher circulating levels of 4PY were strongly associated with development of heart attack, stroke and other adverse cardiac events in large-scale clinical studies. The researchers also showed in preclinical studies that 4PY directly triggers vascular inflammation, which damages blood vessels and can lead to atherosclerosis over time.

Niacin (vitamin B-3) is very common in the Western diet. "For decades, the United States and more than 50 nations have mandated niacin fortification in staple foods such as flour, cereals and oats to prevent disease related to nutritional deficiency," said Dr. Hazen. Yet one in four individuals in the researchers' patient cohorts appear to be getting too much, and had high levels of 4PY, which appears to contribute to cardiovascular disease development.

Dr. Hazen notes broader use of over-the-counter supplements made with different forms of niacin have also become popular because of their presumed anti-aging effects. He says patients should consult with their doctors before taking over-the-counter supplements, and focus on a diet rich in fruit and vegetables while avoiding excess carbohydrates.

Given the findings, the authors suggest that a discussion may be warranted over whether the mandate of flour and cereal fortification with niacin in the US should continue.

To read the abstract of the study, published in Nature Medicine, click here