Mechanisms of the protective effects of nitrate and nitrite in cardiovascular and metabolic diseases
Open accessAbstract
Within the body, NO is produced by nitric oxide synthases via converting l-arginine to citrulline. Additionally, NO is also produced via the NOS-independent nitrate-nitrite-NO pathway. Unlike the classical pathway, the nitrate-nitrite-NO pathway is oxygen independent and viewed as a back-up function to ensure NO generation during ischaemia/hypoxia. Dietary nitrate and nitrite have emerged as substrates for endogenous NO generation and other bioactive nitrogen oxides with promising protective effects on cardiovascular and metabolic function. In brief, inorganic nitrate and nitrite can decrease blood pressure, protect against ischaemia-reperfusion injury, enhance endothelial function, inhibit platelet aggregation, modulate mitochondrial function and improve features of the metabolic syndrome. However, many questions regarding the specific mechanisms of these protective effects on cardiovascular and metabolic diseases remain unclear. In this review, we focus on nitrate/nitrite bioactivation, as well as the potential mechanisms for nitrate/nitrite-mediated effects on cardiovascular and metabolic diseases. Understanding how dietary nitrate and nitrite induce beneficial effect on cardiovascular and metabolic diseases could open up novel therapeutic opportunities in clinical practice.
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The nitrate-nitrite-NO pathway offers an alternative, oxygen-independent mechanism for generating NO, which can partially restore vascular homeostasis under hypoxic or oxidative conditions.
“the nitrate-nitrite-NO pathway offers an alternative, oxygen-independent mechanism for generating NO, which can partially restore vascular homeostasis under hypoxic or oxidative conditions [209,210].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [209]
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Kurhaluk, N., Kołodziejska, R., Buyun, L., Kamiński, P., & Tkaczenko, H. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27083461 · Cited by 3 · see citing works
“In this context, the nitrate-nitrite-NO pathway offers an alternative, oxygen-independent mechanism for generating NO, which can partially restore vascular homeostasis under hypoxic or oxidative conditions [209,210].”
- Authors
- Liu, Y., Croft, K. D., Hodgson, J. M., Mori, T., & Ward, N. C.
- Affiliations
- The University of Western Australia (AU)
- Edith Cowan University (AU)
- Corresponding author
- Ward, Natalie C.
- Venue
- Nitric Oxide
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 96
- Pages
- 35-43
- ISSN
- 1089-8603 (ISSN-L)
- OpenAlex
- W3000630982
- Cited by
- 41
- References
- 53
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 3 · 2023: 6 · 2022: 8 · 2021: 10 · 2020: 4
- FWCI
- 0.89
- Type
- journal article
- Language
- en
- Open access
- green
- ro.ecu.edu.au
- Locations
- Nitric Oxide (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Australasian Journal of Paramedicine (submittedVersion)
- Funders
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
- Keywords
- dietary nitrate, dietary nitrite, nitrate-nitrite-NO pathway, cardiovascular disease, metabolic syndrome, ischemia-reperfusion injury, endothelial function, platelet aggregation, mitochondrial function, blood pressure, hypoxia
- MeSH terms
- Animals, Blood Pressure, Diabetes Mellitus, Endothelium, Vascular, Humans, Hypertension, Pulmonary, Mouth, Nitrates, Nitrites, Platelet Aggregation, Myocardial Reperfusion Injury, Protective Agents, Microbiota
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