Nicotinamide adenine dinucleotide (NAD) and related metabolites are central mediators of fuel oxidation and bioenergetics within cardiomyocytes. Additionally, NAD is required for the activity of multifunctional enzymes, including sirtuins and poly(ADP-ribose) polymerases that regulate posttranslational modifications, DNA damage responses, and Ca signaling. Recent research has indicated that NAD participates in a multitude of processes dysregulated in cardiovascular diseases. Therefore, supplementation of NAD precursors, including nicotinamide riboside that boosts or repletes the NAD metabolome, may be cardioprotective. This review examines the molecular physiology and preclinical data with respect to NAD precursors in heart failure-related cardiac remodeling, ischemic-reperfusion injury, and arrhythmias. In addition, alternative NAD-boosting strategies and potential systemic effects of NAD supplementation with implications on cardiovascular health and disease are surveyed.