About 20.5 million people around the world died from cardiovascular disease in 2021, making it responsible for a third of all deaths globally.

While there are some unmodifiable risk factors for heart disease, including genderTrusted Source, family historyTrusted Source, and ethnicityTrusted Source, there are several preventable causes for cardiovascular disease, including obesityTrusted Source, high cholesterol levelsTrusted Source, high blood pressureTrusted Source, smokingTrusted Source, eating an unhealthy dietTrusted Source, and not getting enough physical activityTrusted Source.

Now, researchers from the Cleveland Clinic Lerner Research Institute have added to the list of potentially modifiable risk factors with a new study reporting high levels of a common B vitamin called niacin in the body may contribute to cardiovascular disease.

Finding a potential link between niacin and heart disease was not the original intention of this study, Dr. Stanley Hazen, The Jan Bleeksma Chair in Vascular Cell Biology and Atherosclerosis, director of the Center for Cardiovascular Diagnostics & Prevention, and director of the Center for Microbiome & Human Health at the Cleveland Clinic Lerner Research Institute, and lead author of this study told Medical News Today.

“Our initial goal was to identify new pathways that contribute to heart disease. Even when treating cardiovascular disease risk factors to goal (e.g. cholesterol, blood pressure, diabetes, etc.), the majority of events (heart attack, stroke, death) continue to occur, or at best, we reduce the event rate by 50%. This means there are other pathways we are not addressing,” Dr. Hazen explained.

Dr. Hazen said he and his team were looking for compounds in the blood that might contribute to the future development of heart attack, stroke, or death independent of traditional risk factors.

“The compound 4PYTrusted Source was identified that is linked to future CVD events — in a U.S. cohort initially, then replication in a U.S. cohort, and further validation in a European cohort,” he continued.

“We then performed preclinical studies (animal model) and cell-based studies — all of which showed this compound contributes to vascular inflammation. 4PY, it turns out, is a breakdown product made from excess niacin,” he told MNT.

Niacin — also known as vitamin B-3 — is one of eight different B vitamins.

Niacin helps the body convert foods eaten into energy. It also helps keep the skin healthyTrusted Source and the nervous systemTrusted Source running smoothly.

As the body cannot make niacin, it needs to get it from the foods we eat or via a supplement.

For example, the body convertsTrusted Source the amino acid tryptophanTrusted Source — found in most animal products, including meat and dairy — into niacin.

Niacin can also naturally be found in legumes, whole grains, nuts, and seeds. And there are also some foods, such as cereals and breads, fortified with niacin.

The body does not store niacin — any excess not used is removed from the body via urine.

For this study, Dr. Hazen and his team studied the fasting plasma from about 1,100 people with stable cardiac health.

Upon analysis, researchers discovered that higher circulating levels of N1-methyl-4-pyridone-3-carboxamide, or 4PY, were strongly associated with the development of a heart attack, stroke, or other unhealthy cardiac events.

“Our studies found high levels of 4PY in the blood predict future cardiac disease. These new studies help identify a new pathway that contributes to heart disease,” Dr. Hazen said.

However, Dr. Hazen said the main takeaway for readers is not that we should cut out our entire intake of niacin — that’s not a realistic or healthy approach.

Scientists also found that 4PY directly triggers vascular inflammation, which can damage blood vessels and lead to a buildup of plaque on artery walls, known as atherosclerosis.

“Atherosclerosis is caused by both high cholesterol and inflammation. We know how to treat the high cholesterol side of the equation, but not the inflammation side. This pathway appears to be a major participant in vascular inflammation,” Dr. Hazen said.