Dietary nitrite and nitrate: a review of potential mechanisms of cardiovascular benefits

Abstract

Purpose: In the last decade, a growing scientific and medical interest has emerged toward cardiovascular effects of dietary nitrite and nitrate; however, many questions concerning their mode of action(s) remain unanswered. In this review, we focus on multiple mechanisms that might account for potential cardiovascular beneficial effects of dietary nitrite and nitrate.

Results: Beneficial changes to cardiovascular health from dietary nitrite and nitrate might result from several mechanism(s) including their reduction into nitric oxide, improvement in endothelial function, vascular relaxation, and/or inhibition of the platelet aggregation. From recently obtained evidence, it appears that the longstanding concerns about the toxicity of oral nitrite or nitrate are overstated.

Conclusion: Dietary nitrite and nitrate may have cardiovascular protective effects in both healthy individuals and also those with cardiovascular disease conditions. A role for nitrite and nitrate in nitric oxide biosynthesis and/or in improving nitric oxide bioavailability may eventually provide a rationale for using dietary nitrite and nitrate supplementation in the treatment and prevention of cardiovascular diseases.

Fig. 1

Schematic presentation of nitric oxide (NO) generation and metabolism in the body. NO is generated from the classical nitric oxide synthase (NOS)-l-arginine pathway and from the reduction of systemic nitrate (${\text{NO}}_3^{-}$) and nitrite (${\text{NO}}_2^{-}$). Systemic ${\text{NO}}_3^{-}\text{ and }{\text{NO}}_2^{-}$ originates from the oxidation of NO in biological fluids and from the diet. ${\text{NO}}_3^{-}$ undergoes reduction to ${\text{NO}}_2^{-}$ and then to NO. Possible ${\text{NO}}_3^{-}\text{ and }{\text{NO}}_2^{-}$ reduction pathways to NO in the body are depicted

Fig. 2

Schematic presentation of potential mechanisms by which dietary nitrite and nitrate could modulate cardiovascular health