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- CRP, C-reactive protein
- [Hb], haemoglobin concentration
- IHD, ischaemic heart disease
- NO, nitric oxide
- NOx, nitric oxide bioavailability
- PC, progenitor cell
- WCC, white cell count
Reduced haemoglobin concentrations ([Hb]) are associated with adverse cardiovascular outcomes in patients with acute coronary syndromes.1 The reasons behind this association may include, in addition to impaired oxygen delivery,1 chronic inflammation,2 reduced erythropoietin activity,1,3 or a general depression of haematopoietic function.4 Indeed, an impoverished circulating reservoir of stem and progenitor cells (PCs) is emerging as a new indicator of cardiovascular risk.4
Nitric oxide (NO), well known for its vasodilatory and antiplatelet actions, is typically reduced in patients with ischaemic heart disease (IHD)5 and may contribute to regulate [Hb]. The type II, cytokine-induced isoform of NO synthase causes haematopoietic suppression in vitro.2 On the other hand, the endothelial (constitutive) type III NO synthase is an essential inducer of marrow cell mobilisation in vivo,6 while the nitric oxide synthase inhibitor, asymmetric dimethylarginine, inhibits the mobilisation, differentiation and function of PCs.5 Moreover, endogenous NO mediates erythropoietin activity3 and promotes the hypoxia inducible factor-1-DNA binding that leads to erythropoietin expression.7
We investigated, in a consecutive series of patients with documented IHD and no known cause of anaemia, whether impaired NO bioavailability (NOx) might be associated with reduced [Hb], possibly helping to explain the adverse outcomes related to lower Hb levels.
Between January and June 2004, 83 patients referred to our Cardiac Care Unit and satisfying our inclusion/exclusion criteria were consecutively enrolled. All patients with documented IHD were eligible for inclusion. …
Competing interests: None.