Recently

cardiovascular diseases (CVDs) were identified as the leading cause of mortality

imposing a heavy burden on health care systems and the social economy. Nicotinamide adenine dinucleotide (NAD

+

)

as a pivotal co-substrate for a range of different enzymes

is involved in many signal transduction pathways activated in CVDs. Emerging evidence has shown that NAD

+

can exert remediating effects on CVDs by regulating metabolism

maintaining redox homeostasis and modulating the immune response. In fact

NAD

+

might delay ageing through sirtuin and non-sirtuin pathways and thus contribute to interventions for age-related diseases such as CVDs. Considering that robust clinical studies of NAD

+

are ongoing

we discuss current challenges and the future translational potential of NAD

+

based on existing studies and our understanding. Despite some remaining gaps in its clinical application

NAD

+

has been shown to have broad prospects and pan-effects

making it a suitable prophylactic drug for CVDs.