Feb. 6, 2004 – It has been well over a century since doctors learned that nitroglycerin was useful for soothing the pulverizing chest torment known as angina that often happens with coronary supply route infection. The treatment is still broadly used today, but a new think about recommends it may eventually harmed heart patients more than it helps them.
Analysts say long-term nitroglycerin utilize appears to advance the generation of unsteady particles known as free radicals, which have been involved within the progression of heart disease. The concern is that the drug’s pain calming benefit comes at the cost of making the patient’s heart condition more awful.
“This is a drug that has been around forever, and it has just been accepted to be secure,” Duke University teacher of medicine Jonathan Stamler, MD, tells WebMD. “Our discoveries and those of others recommend a genuine need to take a new see at it.”
Nitroglycerin calms chest pain by opening contracted blood vessels, permitting more oxygen-rich blood to flow to the heart. But patients rapidly construct up resistance to the sedate in the event that utilized for long periods of time.
It was their endeavors to distinguish the cause of this resistance that driven Stamler and colleagues to conclude that the drug may promote blood vessel damage. Two a long time back, the inquire about group recognized a compound that holds the key to the drug’s ability to widen blood vessels and relieve chest pain. The compound dwells in a part of the cell known as the mitochondria.
In lab considers, they found that exposure to tall dosages of nitroglycerin not only decreased the activity of this compound, but it also harmed the mitochondria. This, in turn, come about in the expanded production of free radicals — unsteady molecules that can damage heart cells and blood vessel walls. The findings are published in the February issue of The Diary of Clinical Investigation.
“Regularly when individuals gotten to be tolerant to this medicate, the response is to push the dose higher,” Stamler says. “But if we now understand that this resilience is related with the production of the same free radicals that have been embroiled in cardiovascular illness, this methodology does not make sense.”
More Ponder Required
In an accompanying publication, cardiologist John D. Parker, MD, notes that other recent ponders have also addressed the long-term safety of nitrate treatment.
“Taken together, these observations propose that the time has come to mount an appropriately fueled clinical trial examining the viability and safety of supported therapy with natural nitrates,” he writes.
In the meantime, Stamler says he accepts clinicians should rethink their dependence on nitroglycerin, particularly among heart patients who also have other medical conditions such as diabetes.
“I would argue that there is enough evidence to at slightest say that the dosages we are utilizing are too high,” he says. “Generally, we got to see much more carefully at how we utilize this sedate.”