Relationship between nitroglycerine-induced vasodilation and clinical severity of peripheral artery disease

Atherosclerosis. 2014 Jul;235(1):65-70. doi: 10.1016/j.atherosclerosis.2014.04.012. Epub 2014 Apr 26.


Objective: Nitroglycerine-induced vasodilation is usually used as a control test for flow-mediated vasodilation (FMD). However, nitroglycerine-induced vasodilation per se has also been reported to be impaired in patients with atherosclerosis. The purpose of this study was to determine the relationship between nitroglycerine-induced vasodilation and the clinical severity of peripheral artery disease (PAD).

Methods and results: We measured nitroglycerine-induced vasodilation and FMD in 144 subjects (mean age: 63.8 ± 15.1 years), including 32 PAD patients with critical limb ischemia (CLI group), 28 PAD patients without CLI (non-CLI group), 60 age- and sex-matched patients without established cardiovascular disease (at-risk group), and 24 healthy subjects (healthy group). Nitroglycerine-induced vasodilation was significantly impaired in the CLI group compared to that in the other three groups (healthy group, 16.0 ± 5.3%; at-risk group, 12.9 ± 3.8%; non-CLI group, 10.3 ± 5.1%; CLI group, 6.7 ± 3.9%; P < 0.05, respectively). Even after multivariate adjustment, the differences remained significant. On the other hand, FMD was significantly impaired in the at-risk, non-CLI, and CLI group compared with that in the healthy group (healthy group, 7.1 ± 2.9%; at-risk group, 3.4 ± 2.3%; non-CLI group, 3.5 ± 2.7%; CLI group, 3.0 ± 2.8%; P < 0.001, respectively), but the differences among the at-risk, non-CLI, and CLI groups were not significant. Multivariate analysis revealed that nitroglycerine-induced vasodilation (odds ratio: 0.77, 95% confidence interval [CI]: 0.61-0.97) and diabetes mellitus (odds ratio: 8.75, 95% CI: 1.74-44.2) were independent variables for CLI in PAD patients.

Conclusions: There was no significant difference in FMD between PAD patients with and those without CLI, but nitroglycerine-induced vasodilation was significantly smaller in PAD patients with CLI compared with those without CLI.

Keywords: Critical limb ischemia; Flow-mediated vasodilation; Nitroglycerine-induced vasodilation; Peripheral artery disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Atherosclerosis / pathology
  • Brachial Artery / pathology
  • Case-Control Studies
  • Endothelium, Vascular / pathology
  • Female
  • Humans
  • Ischemia / pathology
  • Male
  • Middle Aged
  • Nitroglycerin / pharmacology*
  • Peripheral Arterial Disease / physiopathology*
  • Vasodilation*
  • Vasodilator Agents / pharmacology
  • Young Adult


  • Vasodilator Agents
  • Nitroglycerin