Nitrates: new insights into old drugs

Overview

Nitric oxide (NO), a highly unstable gas with a half-life of a few seconds, is the
most important mediator produced by endothelial cells and has several important protective
functions concerning the control of vascular tone, thrombogenesis, fibrinolysis, cell proliferation,
inflammation and endothelial permeability, which are crucial for the maintenance of an
anti-inflammatory, anti-atherogenic and anti-thrombotic state. The exogenous administration
of NO with nitrates has been proposed as possible NO exogenous sources in endothelial dysfunction
therapy and coronary artery disease because of their anti-atherosclerotic effect,
through a reduction in oxidative stress, on low-density lipoprotein (LDL) oxidation, chemotactic
molecules and growth factors, which mediate leukocytal adhesion and proliferation of
vascular smooth cells. Moreover, nitrates show a vasodilatant effect on the venous, arterial
and coronary region with a consequent reduction in preload, afterload and an improvement
in myocardial energetic metabolism. Due to these favorable effects nitrates are indicated not
only in angina pectoris, acute myocardial infarction and pulmonary hypertension or hypertension
crisis, but also in systolic and diastolic heart failure, in the prevention of ischemic and
reperfusion damage after IMA or PCI and in the prevention of post-infarctual remodeling.
Moreover, recent data concerning the protective effects of nitrates on endothelial function,
suggest their possible use in the prevention of endothelial damage and atherogenesis. (Heart
International 2007; 3: 69-77)

Keywords

Nitrates, Nitric oxide, Effects, Clinical indications

Correspondence

Dr. Savina Nodari, Section of Cardiovascular Diseases, Dept. of Experimental and Applied Medicine, University of Brescia c/o Spedali Civili, P.zza Spedali Civili, 1, 25123 Brescia – Italy, nodari@med.unibs.it