Elevated Plasma Nitrate Levels in Patients with Acute Coronary Syndrome

Acute coronary syndrome (ACS) encompasses a spectrum of coronary artery diseases, including unstable angina, non-ST segment elevation myocardial infarction, and ST-segment elevation MI. At present, ACS is a major cause of mortality and morbidity in the community. The diagnosis of ACS is of critical importance for guiding appropriate therapeutic strategies, although this can be onerous if the standard presenting manifestations are lacking. While high-sensitivity cardiac troponin (hs-cTn) is a proven biomarker of ACS, additional markers to support the clinical diagnosis could be valuable. Since nitrate metabolism is crucial to the vasomotion of coronary arteries, in this study, we compared the plasma nitrate levels in consecutive patients with ACS and healthy volunteers. Systemic hemodynamic parameters were also compared between the groups. The pulse wave velocity of individuals with ACS was higher than that in healthy volunteers, thereby verifying the association between coronary artery disease and a loss of vascular elasticity in the circulatory system. Notably, median plasma nitrate levels were significantly higher in patients with ACS compared to healthy volunteers. Although plasma nitrate levels seem to be higher in patients with ACS, whether this finding is incidental, contributory, or a consequential factor in the pathogenesis of ACS remains to be determined.