Nicotinamide Mononucleotide in Patients Undergoing CABG Surgery

Inclusion Criteria:

1. Age ≥18 years

2. Scheduled to undergo elective isolated CABG surgery with cardiopulmonary bypass (CPB)

3. At increased risk of postoperative complications based on ≥1 of the following:

4. Age ≥65 years

5. eGFR <45 ml/min/1.73m2

6. Documented history of congestive heart failure or left ventricular ejectionfraction (LVEF) ≤40% within 6 months before surgery

7. Diabetes mellitus and urine albumin-to-creatinine ratio >30 mg/g creatinine

8. Peripheral arterial disease

9. Anemia, defined as hemoglobin <10 g/dl

10. Prior cardiac surgery

Exclusion Criteria:

1. Any of the following laboratory abnormalities at the time of screening:

2. ALT >3-fold the upper limit of normal

3. eGFR <30 ml/min/1.73m2 or ESKD on dialysis

4. Hemoglobin <8 g/dl

5. History of gastric bypass or malabsorption

6. Active alcohol or illicit substance use in the prior 6 months

7. Participation in an investigational trial to evaluate pharmaceuticals or biologicswithin the past 3 months or 5 half-lives, whichever is shorter

8. Pregnant or breast-feeding

9. Unwillingness to use contraception while taking study drug and for 8 weeks after thelast dose for women of reproductive age or non-sterilized male participants who aresexually active with a female partner of childbearing potential

10. Current use of niacin >100 mg/day or NMN, nicotinamide, or nicotinamide riboside atany dose

11. Conflict with other research studies

12. Any condition which, in the judgement of the investigator, might increase the riskto the participant