[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.