The cardiovascular continuum: from endothelial dysfunction to clinical events. The role of organic nitrates

Overview

The endothelium plays a key role in the regulation of numerous physiological functions,
including fibrinolysis, thrombosis, inflammation, cell growth and the maintenance of vascular
tone. Several studies have shown that endothelial dysfunction is an early event in the
course of the heart failure and changes in vascular reactivity have a series of hemodynamic consequences,
including increases in total peripheral resistance and afterload, worsening of cardiac
performance and a reduction in tolerance to exercise.
Organic nitrates are the oldest drugs used in patients with coronary artery disease and heart failure
and are able to deliver nitric oxide (NO) directly to the vascular wall inducing the well known
vasodilator effects.
Therefore, it is likely that the release of NO by organic nitrates is associated with antiaggregatory,
antiadhesive, antiproliferative and antioxidative effects, all of which are considered to be vasoprotective.
Recent data from animal models suggest that treatment with high doses of isosorbide mononitrate
(ISMN) reduce the progression of atherosclerosis and this reduction of morphologic
changes is associated with an improvement of the endothelial function. Organic nitrates and recent
mononitrates (IS-5-MN and IS-2-MN) appear useful to protect arterial endothelium and inhibit
the progression of the disease in heart failure and ischemic heart disease. (Heart International
2007; 3: 78-85)

Keywords

Ischemic heart disease, Atherosclerosis, Heart failure, Mononitrates, Endothelial dysfunction, Vasodilation, Antioxidative effects, Vasoprotective effects

Correspondence

Prof. Maria Grazia Modena, Cattedra di Cardiologia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Via del Pozzo, 71, 41100 Modena, Italy, mariagrazia.modena@unimore.it