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We read with interest the article by Lai and coworkers1 published in Circulation about the favorable cardiovascular and metabolic effects of inorganic nitrite and metformin in patients with pulmonary hypertension in heart failure with preserved ejection fraction. Accumulating studies have demonstrated the therapeutic effects of stimulating the nitrate–nitrite–nitric oxide (NO) pathway in renal, cardiovascular, and metabolic disorders. However, the underlying mechanisms are still being debated.Patients with metabolic syndrome are generally considered to have a higher risk of developing pulmonary hypertension in heart failure with preserved ejection fraction. In this study, Lai et al …

circulation

Letter by Carlström and Lundberg Regarding Article, “SIRT3-AMP–Activated Protein Kinase Activation by Nitrite and Metformin Improves Hyperglycemia and Normalizes Pulmonary Hypertension Associated With Heart Failure With Preserved Ejection Fraction”