Abstract: In this work, we reviewed the research progress of NAD⁺metabolism mechanism and its effect on aging-related diseases, focusing on the signaling pathways and cellular processes involved in NAD+, as well as its role in health and diseases from the aspects of NAD⁺biosynthesis pathway, consumption pathway and its regulatory mechanism. Based on the mechanism of action of precursors and key enzymes in the NAD⁺metabolic network, the potential therapeutic approaches of NAD⁺metabolism regulation on aging-related diseases were discussed, providing new perspectives for understanding the complex causal relationship between NAD+levels decline and aging-related diseases. The issues to be solved in the process of NAD⁺research and development were summarized from the aspects of the distribution and transportation of NAD+and its precursors, the production and repair of toxic metabolites, and the monitoring and measurement of NAD⁺metabolic dynamics, and finally, the broad prospects for disease treatment and drug development with NAD⁺as the target were prospective.