Circulating nitric oxide metabolites and the risk of cardiometabolic outcomes: a prospective population-based study

Aim: This study was conducted to investigate whether serum NO metabolites (NOx) could predict the occurrence of type 2 diabetes (T2DM), hypertension (HTN) and metabolic syndrome (MetS). Methods: We measured serum NOx concentrations in the Tehran Lipid and Glucose Study participants (aged ≥19 years) and followed them for a median of 7.7 years for the incidence of outcomes. To determine the appropriate cut-off points of serum NOx for predicting clinical events, a random sampling method (50:50 ratio) was used for the population and for analysis, receiver operator characteristic curve was used. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) with 95% confidence intervals (95% CIs) of T2DM, HTN and MetS in response to serum NOx values. Results: The optimal cut-off points of serum NOx levels for predicting T2DM, HTN and MetS were 26.5, 25.5 and 25.5 µmol/L, respectively. Participants with serum NOx levels ≥25.5 µmol/L had increased risk of MetS (HR = 1.31, 95% CI = 1.01-1.72). No evidence was found for any association of serum NOx with incidence of T2DM and HTN (HR = 1.03, 95% CI = 0.83-1.77 and HR = 1.09, 95% CI = 0.88-1.35). Conclusion: In this prospective population-based investigation, a higher circulating NOx was associated with development of MetS.