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VIEWPOINT

Nitrate-Induced Toxicity and Preconditioning

A Rationale for Reconsidering the Use of These Drugs

Tommaso Gori, MD, PhD^_*,,_* and John D. Parker, MD, FACC

^_* Department of Internal, Cardiovascular, and Geriatric Medicine, University of Siena, Siena, Italy
Medizinische Klinik, University of Mainz, Mainz, Germany
Division of Cardiology, Department of Medicine, Mount Sinai and University Health Network Hospitals, University of Toronto, Toronto, Ontario, Canada.

Manuscript received January 4, 2008; revised manuscript received March 26, 2008, accepted April 3, 2008.

^_* Reprint requests and correspondence: Dr. Tommaso Gori, Department of Internal, Cardiovascular, and Geriatric Medicine, University of Siena, Via Ciacci 42, Siena, Tuscany 53100, Italy. (Email: tommaso.gori{at}utoronto.ca).

Although organic nitrates have been clinically used for more than a century, findings in the last decade have radically challenged our traditional view concerning the mechanism(s) of their clinical effects and implications. While their hemodynamic properties are well known, the knowledge that nitrates possess previously unexpected nonhemodynamic effects is a unique opportunity of which clinicians should be aware but, at the same time, it also provides a rationale to worry about previously unanticipated clinical consequences of long-term treatment with these drugs.

Key Words: nitroglycerin • ischemia • angina • preconditioning

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