Nitrates – ABC CARDIOL

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Research Letter

Personalized Treatment of Heart Failure with Reduced Ejection Fraction: Ivabradine, Nitrate/Hydralazine, and Digoxin – A Systematic Review and Meta-Analysis

Ivna Girard Cunha Vieira Lima et al. Edimar Alcides Bocchi

Introduction

In the last 30 years, treatment of chronic heart failure with reduced ejection fraction (HFrEF) has evolved considerably, and a significant reduction was achieved in mortality over time and hospitalization rates for chronic heart failure (CHF).

Neurohormonal blockade has become key in the treatment of CHF, but with the discovery of new therapies such as sodium-glucose cotransporter-2 inhibitors (SGLT2i), neprilysin inhibitors, resynchronization therapies, and new procedures, the number of treatment options in addition to standard therapy has increased considerably. However, it is known that the start of medications that reduce outcomes in CHF has historically been recommended following the order of publication of efficacy trials. Considering the many treatment options available today, a clinical question arises: is it possible to personalize additional treatments according to the patient’s clinical characteristics? This meta-analysis aims to look for populations of interest where ivabradine, hydralazine and nitrate, and digoxin could have incremental beneficial effects.

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Original Article

Effects of Nitrate Intake on Myocardial Ischemia-Reperfusion Injury in Diabetic Rats

Sajad Jeddi et al. Saeedeh Khalifi Mahboubeh Ghanbari Fatemeh Bageripour Asghar Ghasemi

Abstract

Background:

Coronary artery disease is 2-3 times more common in diabetic individuals. Dietary nitrate/nitrite has beneficial effects in both diabetes and cardiovascular disease. It also has protective effects against myocardial ischemia-reperfusion (IR) injury in healthy animals. However, the effects of nitrate on myocardial IR injury in diabetic rats have not yet been investigated.

Objective:

We examined the effects of dietary nitrate on myocardial IR injury in streptozotocin-nicotinamide-induced diabetic rats.

Method:

Rats were divided into four groups (n=7 in each group): control, control+nitrate, diabetes, and diabetes+nitrate. Type 2 diabetes was induced by injection of streptozotocin and nicotinamide. Nitrate (sodium nitrate) was added to drinking water (100 mg/L) for 2 months. The hearts were perfused in a Langendorff apparatus at 2 months and assessed before (baseline) and after myocardial IR for the following parameters: left ventricular developed pressure (LVDP), minimum and maximum rates of pressure change in the left ventricle (±dP/dt), endothelial nitric oxide (NO) synthase (eNOS) and inducible NO synthase (iNOS) mRNA expression, and levels of malondialdehyde (MDA) and NO metabolites (NOx).

Results:

Recovery of LVDP and ±dP/dt was lower in diabetic rats versus controls, but almost normalized after nitrate intake. Diabetic rats had lower eNOS and higher iNOS expression both at baseline and after IR, and dietary nitrate restored these parameters to normal values after IR. Compared with controls, heart NOx level was lower in diabetic rats at baseline but was higher after IR. Diabetic rats had higher MDA levels both at baseline and after IR, which along with heart NOx levels decreased following nitrate intake.

Conclusion:

Dietary nitrate in diabetic rats provides cardioprotection against IR injury by regulating eNOS and iNOS expression and inhibiting lipid peroxidation in the heart.