Let’s talk about Nitric Oxide

 Let’s talk about Nitric Oxide (NO)

Cardiovascular disease (CVD) remains the number one killer worldwide.  CVD is mainly caused by endothelial dysfunction and one of the main functions of the endothelium is to produce Nitric Oxide (NO) hence it’s critically important for us to talk about this functional loss of NO.  This loss of NO precedes the structural changes of arteriosclerosis and atherosclerosis by many years, sometimes decades.

It’s important to construct a new paradigm in our focus on CVD – one that works to restore NO in healthy individuals without CVD or those at risk for CVD.  This paradigm stands in contradistinction to our current model which focuses on disease states in individuals who already suffer from CVD.  There are three finite responses by the vascular endothelium to an infinite number of insults it encounters.  These three responses are inflammation, oxidative stress and immune dysfunction, all of which lead to a decrease in NO.

Early detection of endothelial dysfunction and recognition of the loss of NO before the onset of progression of symptoms and disease is essential and necessary for the prevention of CVD. Prevention is much more cost-effective than treatment!  One way of testing NO status is to use salivary test strips (which I use in my office) that can give a good indication of total NO available in the body.  Other tests looking indirectly at NO as part of a cardiac work up include high-sensitivity C Reactive Protein (hsCRP), myeloperoxidase (MPO), Lipoprotein associated phospholipase A2 (Lp-PLA2), oxidized LDL amongst others.

The only FDA approved drug therapy that has NO as a mechanism of action are organic nitrates such as nitroglycerin or isosorbide.  However, it is always best to use diet and lifestyle as the first-line therapy for patients at risk for CVD.  Various dietary supplements can also safely rest NO levels such as the inorganic nitrate found in beetroot.

Overall the science pertaining to NO is clear.  The challenge is the education of patients and physicians alike as to what the science says how to implement tools for diagnosing endothelial dysfunction and managing it appropriately.  If we do that, we may be able to move the needle in the treatment of CVD.