New Research Shows that Nicotinamide Riboside is Helpful for People with Peripheral Artery Disease


Peripheral artery disease (PAD) is the buildup of calcium and fatty deposits in the walls of the arteries which reduces blood flow and increases the risk of stroke or heart attack. It’s estimated that about eight million Americans 40 years older or older have PAD with the most common form being lower extremity PAD which reduces blood flow to the legs and feet. Approximately one in four people with PAD have muscle pain or weakness that occurs with physical activity such as walking. New research demonstrates that nicotinamide riboside (NR) can help.

This new study randomized 90 people with PAD to receive NR with or without resveratrol or placebo for six months. The key outcome was walking distance after six minutes. In the post-hoc analysis, the total walking distance in the NR group improved by nearly 102 feet, and the NR plus resveratrol group gained an extra 88+ feet. The researchers pointed out that compliance in the NR group was 75 percent while compliance in the NR plus resveratrol group was 52 percent so that could explain the difference in outcomes between the two groups.

“The study by McDermott et al. showed that NR not only increased walking distance, but it also significantly increased gastrocnemius muscle satellite cell abundance,” explained Angela D. Mazza, DO, who is triple board certified in endocrinology, internal medicine, and aging and regenerative medicine. “These findings support the benefits of NR, as a precursor to NAD+, in reducing oxidative stress.”

Nicotinamide Adenine Dinucleotide (NAD+) and its Precursors

Research demonstrates that NAD+ is a coenzyme that influences health on a deep cellular level including mitochondrial homeostasis, cell signaling, circadian rhythm, DNA repair, transcription regulation, energy metabolism, and the immune response. It is also known that NAD+ levels decline with age, which increases the risk of chronic diseases including cardiovascular health issues such as PAD.

Dr. Mazza uses NAD+ and its precursors NR and nicotinamide mononucleotide (NMN) in her clinical practice at Metabolic Center for Wellness in Oviedo, FL, where she is the founder and Medical Director.

“NAD+ and its precursors have broad clinical applications because NAD+ plays such a critical role in cellular energy production and activates enzymes in the sirtuin family, which are the master switches of metabolism,” explained Dr. Mazza who is also a thyroid expert and the author of the book Thyroid Talk: An Integrative Guide to Optimal Thyroid Health. “For my patients interested in healthy aging, I appreciate the fact that NAD+ and its precursors also help enhance cellular longevity.”

According to a review from this year, preclinical research indicates that supplementation of NAD+ precursors elevates NAD+ levels and can help reduce the risk of metabolic syndrome, enhance cardiovascular health, protect against neurodegeneration, and boost muscular strength. The researchers concluded that more human clinical trials are needed to confirm these benefits.

A 2022 review found that preclinical research is promising regarding the use of NAD+ precursors for different forms of dementia and cognitive recovery after stroke, but the research on traumatic brain injury has been inconsistent.

“From a clinical standpoint, this latest study suggests the benefits of NR, not only in persons with PAD, but other similar inflammatory disease states,” said Dr. Mazza. “The growing amount of research involving NAD+ precursors for healthy aging shows great promise and will be exciting to follow.”

Dr. Mazza was a recent guest on the Natural Medicine Journal Podcast where she talked in detail about her healthy aging protocol which often includes the use of NAD+ and its precursors.