title: Impact of Chronic Nitrate Therapy in Patients With Ischemic Heart Failure.
abstract: There is a lack of knowledge on the effects of nitrates alone in heart failure (HF). We aimed to assess the impact of nitrates use in the occurrence of ischemic events in patients with ischemic HF attending an HF clinic.
  
  
  
  We performed a retrospective analysis of a cohort of 632 patients managed in an HF clinic between January 2000 and December 2011. Patients with ischemic etiology were selected (n = 290). Patients were classified according to chronic nitrates use (n = 83 nitrates users vs n = 194) and followed up for 5 years for the occurrence of fatal or nonfatal myocardial infarction or stroke.
  
  
  
  Nitrates users had more frequently diabetes, dyslipidemia, and higher body mass index but were less frequently treated with statins. Thirty adverse events were recorded (n = 16 in nitrates group). Variables significantly associated with the occurrence of the end point in univariate analysis were arterial hypertension, diabetes, and nitrates use. Male gender, beta-blockers, statin, and clopidogrel use had a protective effect on the occurrence of the end point. In multivariate analysis, nitrates use remained an independent predictor of adverse outcome when adjusted for each of the variables: arterial hypertension, gender, diabetes, beta-blocker, and clopidogrel use; however, when adjusted for statin use, nitrates were no longer associated with the outcome.
  
  
  
  Long-term nitrates use in patients with ischemic HF was associated with higher occurrence of ischemic events, defined as fatal or nonfatal myocardial infarction or stroke. Our results, although from a retrospective analysis, do not support a role for chronic nitrate use in HF.
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, Porto, Portugal siamms@gmail.com.
authors.forename: Sofia
authors.initials: S
authors.lastname: Moreira-Silva
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Urbano
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, Porto, Portugal Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Nogueira-Silva
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, Porto, Portugal Department of Medicine & Unit of Cardiovascular Research & Development, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, Porto, Portugal Department of Medicine & Unit of Cardiovascular Research & Development, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Pimenta
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D009566:Nitrates / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D009566:Nitrates; D014665:Vasodilator Agents
keywords: ischemic heart failure; nitrates; prognosis