Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Feb;24(2):65-73.
doi: 10.1016/j.cardfail.2017.09.004. Epub 2017 Sep 12.

Dietary Nitrate Increases VO2peak and Performance but Does Not Alter Ventilation or Efficiency in Patients With Heart Failure With Reduced Ejection Fraction

Andrew R Coggan  1 , Seth R Broadstreet  2 , Kiran Mahmood  3 , Deana Mikhalkova  3 , Michael Madigan  3 , Indra Bole  3 , Soo Park  3 , Joshua L Leibowitz  3 , Ana Kadkhodayan  3 , Deepak P Thomas  3 , Dakkota Thies  4 , Linda R Peterson  5
Affiliations
Randomized Controlled Trial

Dietary Nitrate Increases VO2peak and Performance but Does Not Alter Ventilation or Efficiency in Patients With Heart Failure With Reduced Ejection Fraction

Andrew R Coggan et al. J Card Fail. 2018 Feb.

Abstract

Background: Patients with heart failure with reduced ejection fraction (HFrEF) exhibit lower efficiency, dyspnea, and diminished peak oxygen uptake (VO2peak) during exercise. Dietary nitrate (NO3-), a source of nitric oxide (NO), has improved these measures in some studies of other populations. We determined the effects of acute NO3- ingestion on exercise responses in 8 patients with HFrEF using a randomized, double-blind, placebo-controlled, crossover design.

Methods and results: Plasma NO3-, nitrite (NO2-), and breath NO were measured at multiple time points and respiratory gas exchange was determined during exercise after ingestion of beetroot juice containing or devoid of 11.2 mmol of NO3-. NO3- intake increased (P < .05-0.001) plasma NO3- and NO2- and breath NO by 1469 ± 245%, 105 ± 34%, and 60 ± 18%, respectively. Efficiency and ventilation during exercise were unchanged. However, NO3- ingestion increased (P < .05) VO2peak by 8 ± 2% (ie, from 21.4 ± 2.1 to 23.0 ± 2.3 mL.min-1.kg-1). Time to fatigue improved (P < .05) by 7 ± 3 % (ie, from 582 ± 84 to 612 ± 81 seconds).

Conclusions: Acute dietary NO3- intake increases VO2peak and performance in patients with HFrEF. These data, in conjunction with our recent data demonstrating that dietary NO3- also improves muscle contractile function, suggest that dietary NO3- supplementation may be a valuable means of enhancing exercise capacity in this population.

Keywords: Nitric oxide; VO(2)peak; exercise; heart failure.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CONSORT diagram illustrating flow of subjects through the study.
Figure 2
Figure 2
Experimental design (top panel) and protocol (bottom panel).
Figure 3
Figure 3
Effect of acute ingestion of beetroot juice either devoid of (Placebo; open bars) or containing (Nitrate; solid bars) 11.2 mmol of NO3- on plasma NO3- (top panel) and NO2- (middle panel) concentrations and breath NO levels (bottom panel) in patients with heart failure with reduced ejection fraction. Values are mean ± SE for n=8. 10′ Post = 10 min post-exercise. Nitrate significantly higher than than Placebo at same time point: *P<0.05, †P<0.01, ‡P<0.001.
Figure 4
Figure 4
Effect of acute ingestion of beetroot juice either devoid of (Placebo; open bar or symbols) or containing (Nitrate; solid bar or symbols) 11.2 mmol of NO3- on time to fatigue (top panel) and peak O2 consumption (VO2peak; bottom panel) during an incremental exercise test in patients with heart failure with reduced ejection fraction. Values are mean ± SE for n=8; individual results are also shown (circles, men; squares, women). *Nitrate significantly higher than Placebo: P<0.05.
See this image and copyright information in PMC

Comment in

References

    1. Adachi H, Nguyen PH, Belardinelli R, Hunter D, Jung T, Wasserman K. Nitric oxide production during exercise in chronic heart failure. Am Heart J. 1997;134:196–202. - PubMed
    1. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/CIR.0000000000000485. - DOI - PMC - PubMed
    1. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J. 2004;147:354–360. doi: 10.1016/j.ahj.2003.07.014. - DOI - PubMed
    1. Baba R, Nagashima M, Goto M, Nagano Y, Yokota M, Tauchi N, Nishibata K. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol. 1996;28:1567–72. - PubMed
    1. Bailey SJ, Fulford J, Vanhatalo A, Winyard PG, Blackwell JR, DiMenna FJ, Wilkerson DP, Benjamin N, Jones AM. Dietary nitrate supplementation enhances muscle contractile efficiency during knee-extensor exercise in humans. J Appl Physiol. 2010;109:135–148. doi: 10.1152/japplphysiol.00046.2010. - DOI - PubMed

Publication types