Effect of dietary nitrate ingestion in Heart Failure (DiNOmo-HF)
Research type
Research Study
Full title
Investigation of Dietary Nitrate Optimisation by hyperuricaemia stratification in Heart Failure (DiNOmo-HF)
IRAS ID
195099
Contact name
Amrita Ahluwalia
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
2 years, 11 months, 29 days
Research summary
Around 900,000 people in the UK suffer with heart failure. Patients experience significant ill-health and many die of the condition. Treatment focuses on improving prognosis and symptoms, with few new therapies successfully developed in recent years.
We know that patients with heart disease have reduced levels of the beneficial molecule nitric oxide (NO). Finding a way to replace it is therefore important. Patients have long received intravenous and oral “organic” nitrates to do this, but rapidly develop tolerance. We have identified an alternative method that avoids this, using dietary "inorganic" nitrate. Using once daily nitrate-rich beetroot juice, we have demonstrated beneficial effects in patients with high blood pressure and those having heart attacks.
Many people with heart failure have high uric acid levels, which can cause gout. High levels are associated with worse outcomes. A recent large trial in heart failure used a common treatment for gout (allopurinol) to investigate whether it improved outcomes. The study did not show the expected benefits in cardiac status, but there was a trend towards fewer and slower heart failure re-hospitalisations. This is important as re-admissions are common, and are associated with worsening heart health.
Crucially, the enzyme on which allopurinol acts also plays an important role in NO generation from inorganic nitrate. It has therefore been suggested that the positive effects of allopurinol might be enhanced, if coupled with NO delivery.We wish to test this concept using inorganic dietary nitrate through a randomised-control trial, where some receive nitrate-rich and others nitrate-deplete (placebo) juice daily for 12-weeks. We will recruit 92 patients from the heart failure clinics of Barts Heart Centre, Royal London and University College London Hospitals and assess cardiac dysfunction at the beginning and end of the study, with measures including blood tests, cardiac MRI and quality of life questionnaires.
REC name
London - City & East Research Ethics Committee
REC reference
17/LO/1624
Date of REC Opinion
19 Oct 2017
REC opinion
Favourable Opinion