Association of serum nitric oxide metabolite level with mortality in patients undergoing coronary angiography

Background: Nitric oxide (NO) is a relevant molecule for vascular homeostasis. The level of serum NO metabolites (NOx), which consist of nitrite and nitrate, has been investigated as an alternative biomarker of NO production, but its clinical value has not yet been determined.Methods and results: 143 patients (66 +/- 12 years old) were followed up after coronary catheterization. During a median (inter-quartile range) observation period of 6.13 (3.32-9.21) years, there were 20 (14 %) all-cause deaths, including 11 (8 %) cardiovascular deaths, 17 (12 %) major adverse cardiovascular events, and 17 (12 %) hospital admissions for heart failure. Median NOx level was 34.5 mu mol/L (23.9-54.3). NOx was a risk factor for all -cause death [hazard ratio (HR) by unit increase, 1.010, 95 % confidence interval (CI) 1.001-1.018; p = 0.021] and heart failure (HR 1.010, CI 1.001-1.019; p = 0.029). Even after adjustment for age, sex, coronary risk factors, C-reactive protein, log-transformed brain natriuretic peptide, estimated glomerular filtration rate, and nitrate treatment, NOx was a risk factor for all-cause death (HR 1.015, CI 1.004-1.027; p = 0.008) and admission with heart failure (HR 1.018, CI 1.005-1.018, p = 0.007).Conclusions: An increase in serum NOx level does not herald a benign clinical course but is an independent pre-dictor of high risk of any-cause mortality and heart failure.(c) 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Automated summary

The study found that serum nitric oxide metabolites (NOx) level is a risk factor for all-cause death and heart failure, even after adjusting for other influencing factors.