[NAD metabolism in cardiovascular diseases].

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Nicotinamide adenine dinucleotide (NAD) is a central and pleiotropic metabolite involved in multiple cellular energy metabolism, such as cell signaling, DNA repair, protein modifications, and so on. Evidence suggests that NAD levels decline with age, obesity, and hypertension, which are all significant CVD risk factors. In addition, the therapeutic elevation of NAD levels reduces chronic low-grade inflammation, reactivates autophagy and mitochondrial biogenesis, and enhances antioxidation and metabolism in vascular cells of humans with vascular disorders. In preclinical animal models, NAD boosting also extends the health span, prevents metabolic syndrome, and decreases blood pressure. Moreover, NAD storage by genetic, pharmacological, or natural dietary NAD-increasing strategies has recently been shown to be effective in improving the pathophysiology of cardiac and vascular health in different animal models and humans. Here, we discuss NAD-related mechanisms pivotal for vascular health and summarize recent research on NAD and its association with vascular health and disease, including hypertension, atherosclerosis, and coronary artery disease. This review also assesses various NAD precursors for their clinical efficacy and the efficiency of NAD elevation in the prevention or treatment of major CVDs, potentially guiding new therapeutic strategies.