Department of Advanced Clinical and Surgical Sciences, 18994University of Campania "Luigi Vanvitelli," Naples, Italy.
U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Clinical Department of Internal Medicine and Specialistics, 18994University of Campania "L. Vanvitelli," Naples, Italy.
Angiology. 2021 May;72(5):411-425. doi: 10.1177/0003319720979243. Epub 2021 Jan 22.
Nitric oxide (NO) is a powerful mediator with biological activities such as vasodilation and prevention of vascular smooth muscle cell proliferation as well as functional regulation of cardiac cells. Thus, impaired production or reduced bioavailability of NO predisposes to the onset of different cardiovascular (CV) diseases. Alterations in the redox balance associated with excitation-contraction coupling have been identified in heart failure (HF), thus contributing to contractile abnormalities and arrhythmias. For its ability to influence cell proliferation and angiogenesis, NO may be considered a therapeutic option for the management of several CV diseases. Several clinical studies and trials investigated therapeutic NO strategies for systemic hypertension, atherosclerosis, and/or prevention of in stent restenosis, coronary heart disease (CHD), pulmonary arterial hypertension (PAH), and HF, although with mixed results in long-term treatment and effective dose administered in selected groups of patients. Tadalafil, sildenafil, and cinaguat were evaluated for the treatment of PAH, whereas vericiguat was investigated in the treatment of HF patients with reduced ejection fraction. Furthermore, supplementation with hydrogen sulfide, tetrahydrobiopterin, and nitrite/nitrate has shown beneficial effects at the vascular level.
一氧化氮（NO）是一种具有生物活性的强大介质，具有血管扩张、预防血管平滑肌细胞增殖以及心脏细胞功能调节等作用。因此，NO 的产生受损或生物利用度降低会导致不同心血管（CV）疾病的发生。与兴奋-收缩偶联相关的氧化还原平衡的改变已在心力衰竭（HF）中得到确定，从而导致收缩异常和心律失常。由于其影响细胞增殖和血管生成的能力，NO 可能被视为管理多种 CV 疾病的治疗选择。几项临床研究和试验研究了治疗性 NO 策略在系统性高血压、动脉粥样硬化和/或预防支架内再狭窄、冠心病（CHD）、肺动脉高压（PAH）和 HF 中的应用，但在长期治疗和有效剂量方面的结果不一致在选定的患者群体中给予。西地那非、他达拉非和 cinaguat 被评估用于治疗 PAH，而 vericiguat 则被用于治疗射血分数降低的 HF 患者。此外，补充硫化氢、四氢生物蝶呤和亚硝酸盐/硝酸盐在血管水平显示出有益的效果。
