Inorganic Nitrite to Amplify the Benefits and Tolerabilit... | NCT02713126

NCT02713126

ID	Type	Description	Link
R01HL128526	U.S. NIH Grant/Contract		View source

Status Module

Sponsor/Collaborators Module

Name	Class
National Heart, Lung, and Blood Institute (NHLBI)	NIH

Oversight Module

Description Module

Conditions Module

Design Module

Interventional Study Design

Biospecimen

No data available

No data is available for this block.

Arms/Interventions Module

Arm Groups

Label	Type	Description	Intervention Names
Placebo	Placebo Comparator	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer	Drug: Placebo Device: Accelerometer Other: Cardiac Exercise Training
Sodium Nitrite	Active Comparator	Subjects will undergo cardiac exercise training and receive inhaled or oral sodium nitrite three times per day for 12 weeks while wearing an accelerometer	Drug: Sodium Nitrite Device: Accelerometer Other: Cardiac Exercise Training

Name	Type	Description	Arm Group Labels	Other Names
Placebo	Drug	administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks	Placebo

Outcomes Module

Primary Outcomes

Measure	Description	Time Frame
Change in Peak Rate of Oxygen (VO2)	Exercise capacity as measured by the peak rate of oxygen (VO2) consumption achieved during exercising testing. Peak VO2 is expressed as milliliters of oxygen per kilogram of body mass per minute.	Baseline, 12 weeks

Secondary Outcomes

Measure	Description	Time Frame
Change in Daily Activity Levels	The change in daily activity levels as assessed by accelerometer data and reported as average accelerometry units.	Baseline, 12 weeks
Change in Cardiac Hemodynamics

Eligibility Module

Eligibility Criteria

Inclusion Criteria:

Age ≥ 40 years
Symptoms of dyspnea (II-IV) without evidence of a non-cardiac or ischemic explanation for dyspnea
Ejection Fraction (EF) of > or = 50% determined on most recent imaging study within the preceding 5 years, with no change in clinical status suggesting potential for deterioration in systolic function
One of the following:
- Previous hospitalization for Heart Failure (HF) with radiographic evidence (pulmonary venous hypertension, vascular congestion, interstitial edema, pleural effusion) of pulmonary congestion or
- Catheterization documented elevated filling pressures at rest (Pulmonary Capillary Wedge Pressure (PCWP)= ≥15 or Left Ventricular End-Diastolic Pressure (LVEDP) ≥18) or with exercise (PCWP ≥25) or
- Elevated Natruretic Peptide-proBNP (>400 pg/ml) or B-Type Natriuretic Peptide (BNP)(>200 pg/ml) or
- Echo evidence of diastolic dysfunction/elevated filling pressures manifest by medial E/e' ratio≥15 and/or left atrial enlargement and chronic treatment with a diuretic for signs or symptoms of heart failure
Heart failure is primary factor limiting activity as indicated by answering # 2 to the following question:

My ability to be active is most limited by:

Joint, foot, leg, hip or back pain
Shortness of breath and/or fatigue and/or chest pain
Unsteadiness or dizziness
Lifestyle, weather, or I just don't like to be active
- No chronic nitrate therapy or not using intermittent sublingual nitroglycerin (requirement for >1 sublingual nitroglycerin per week).
- No daily use of phosphodiesterase 5 (PDE5) inhibitors or soluble guanylyl cyclase activators and willing to withhold as needed use of PDE5 inhibitors for duration of study
- Ambulatory (not wheelchair / scooter dependent)
- Body size allows wearing of the accelerometer belt as confirmed by ability to comfortably fasten the test belt provided for the screening process.
- Willingness to wear the accelerometer belt for the duration of the trial

Exclusion Criteria:

Recent (< 1 month) hospitalization for heart failure
Ongoing requirement for PDE5 inhibitor, organic nitrate or soluble guanylyl cyclase activators
Hemoglobin (Hgb) < 8.0 g/dl within 30 days prior to randomization
Glomerular Filtration Rate (GFR) < 20 ml/min/1.73 m2 within 30 days prior to randomization
Systolic blood pressure < 115 mmHg seated or < 90 mmHg standing
Resting Heart Rate > 110
Previous adverse reaction to the study drug which necessitated withdrawal of therapy
Significant chronic obstructive pulmonary disease that is a primary contributor to symptoms, in the opinion of the Investigator.
Ischemia thought to contribute to dyspnea, in the opinion of the Investigator.
Documentation of previous Ejection Fraction < 40%
Acute coronary syndrome within 3 months defined by electrocardiographic (ECG) changes and biomarkers of myocardial necrosis (e.g., troponin) in an appropriate clinical setting (chest discomfort or anginal equivalent)
Percutaneous Coronary Intervention, coronary artery bypass grafting, or new biventricular pacing within past 3 months
Obstructive hypertrophic cardiomyopathy
Known infiltrative cardiomyopathy (amyloid)
Constrictive pericarditis or tamponade
Active myocarditis
Complex congenital heart disease
Active collagen vascular disease
More than mild aortic or mitral stenosis
Intrinsic (prolapse, rheumatic) valve disease with more than moderate mitral, tricuspid or aortic regurgitation
Acute or chronic severe liver disease as evidenced by any of the following: encephalopathy, variceal bleeding, International Normalized Ratio (INR) > 1.7 in the absence of anticoagulation treatment
Terminal illness (other than HF) with expected survival of less than 1 year
Enrollment or planned enrollment in another therapeutic clinical trial in next 3 months.
Inability to comply with planned study procedures
Pregnancy or breastfeeding mothers

Contacts/Locations Module

Name	Affiliation	Role
Barry A Borlaug, MD	Mayo Clinic	Principal Investigator

Facility	Status	City	State	ZIP	Country	Contacts
Mayo Clinic		Rochester	Minnesota	55905	United States

References Module

Citations

PubMed Identifier	Type	Citation	Retractions
38127015	Derived	Borlaug BA, Koepp KE, Reddy YNV, Obokata M, Sorimachi H, Freund M, Haberman D, Sweere K, Weber KL, Overholt EA, Safe BA, Omote K, Omar M, Popovic D, Acker NG, Gladwin MT, Olson TP, Carter RE. Inorganic Nitrite to Amplify the Benefits and Tolerability of Exercise Training in Heart Failure With Preserved Ejection Fraction: The INABLE-Training Trial. Mayo Clin Proc. 2024 Feb;99(2):206-217. doi: 10.1016/j.mayocp.2023.08.031. Epub 2023 Dec 21.
37565977	Derived

Label	URL
Mayo Clinic Clinical Trials	View source

IPD Sharing Statement Module

Results Section

Participant Flow Module

Arm/Group Information

ID	Title	Description
FG000	Placebo	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer Placebo: administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.

Baseline Characteristics Module

Outcome Measures Module

Adverse Events Module

More Info Module

Annotation Section

No data available

No data is available for this block.

Document Section

Large Document Module

Uploaded Document Information

Type	Includes Protocol	Includes SAP	Includes ICF	Document Label	Document Date	Document Uploaded Date	Document File Name
Prot_SAP	Yes	Yes	No	Study Protocol and Statistical Analysis Plan	Feb 10, 2021

Derived Section

Miscellaneous Info Module

Submission Tracking

No data available

No data is available for this block.

Condition Browse Module

Intervention Browse Module

Masking Info

The change in cardiac hemodynamics as measured by echocardiography. The E/e' ratio is a marker used to evaluate the left ventricular (LV) filling pressures during exercise. An E/e' ratio of <8 is considered to be normal, a ratio >15 is considered to reflect an increase in the LV filling pressure.

Type of Units Analyzed

Arm/Group Information

ID	Title	Description
BG000	Placebo	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer Placebo: administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.
BG001	Sodium Nitrite	Subjects will undergo cardiac exercise training and receive inhaled or oral sodium nitrite three times per day for 12 weeks while wearing an accelerometer Sodium Nitrite: administered orally or inhaled, 40 mg, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.
BG002	Total	Total of all reporting groups

Units	Counts
Participants	BG00036 BG00137 BG00273

Baseline Measures

Title

Description

Population Description

Parameter Type

Dispersion Type

Unit of Measure

Calculate Percentage

Denominator Units Selected

Denominators

Classes

Age, Continuous

Median

Inter-Quartile Range

years

Title

Denominators

Categories

Title	Measurements
	BG00073.5(68.7 to 76.5) BG00172.0(64.9 to 76.0) BG00272.4(66.4 to 76.2)

Sex: Female, Male

Count of Participants

Participants

Title

Denominators

Categories

Title	Measurements
Female	BG00020 BG00114 BG002

Race (NIH/OMB)

Count of Participants

Participants

Title

Denominators

Categories

Title	Measurements
American Indian or Alaska Native	BG0000 BG0010 BG002

Region of Enrollment

Number

participants

Title

Denominators

Categories

United States

Title	Measurements
	BG00036 BG00137 BG002

Type

Title

Description

Population Description

Reporting Status

Anticipated Posting Date

Parameter Type

Dispersion Type

Unit of Measure

Calculate Percentage

Time Frame

Units Analyzed

Denominator Units Selected

Arm/Group Information

Denominators

Classes

Analyses

Primary

Change in Peak Rate of Oxygen (VO2)

Exercise capacity as measured by the peak rate of oxygen (VO2) consumption achieved during exercising testing. Peak VO2 is expressed as milliliters of oxygen per kilogram of body mass per minute.

Posted

Mean

Standard Deviation

ml/min/kg

Baseline, 12 weeks

ID	Title	Description
OG000	Placebo	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer Placebo: administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.
OG001	Sodium Nitrite	Subjects will undergo cardiac exercise training and receive inhaled or oral sodium nitrite three times per day for 12 weeks while wearing an accelerometer Sodium Nitrite: administered orally or inhaled, 40 mg, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.

Units	Counts
Participants	OG00034 OG00131

Title

Denominators

Categories

Title	Measurements
	OG0000.85± 2.10 OG0010.70± 1.51

Group IDs	Group Description	Statistical Method	Statistical Comment	P-Value	P-Value Comment	Parameter Type	Parameter Value	Dispersion Type	Dispersion Value	Confidence Interval Sides	Confidence Interval %	CI Lower Limit	CI Upper Limit	CI Lower Limit Comment	CI Upper Limit Comment	Estimate Comment	Tested Non-Inferiority	Non-Inferiority Type	Non-Inferiority Comment	Other Analysis Description
OG000 OG001		t-test, 2 sided		0.770														Superiority

Secondary

Change in Daily Activity Levels

The change in daily activity levels as assessed by accelerometer data and reported as average accelerometry units.

Posted

Mean

Standard Deviation

accelerometry units (AU)

Baseline, 12 weeks

ID	Title	Description
OG000	Placebo	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer Placebo: administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.
OG001	Sodium Nitrite	Subjects will undergo cardiac exercise training and receive inhaled or oral sodium nitrite three times per day for 12 weeks while wearing an accelerometer Sodium Nitrite: administered orally or inhaled, 40 mg, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.

Secondary

Change in Cardiac Hemodynamics

Posted

Mean

Standard Deviation

ratio

Baseline, 12 weeks

ID	Title	Description
OG000	Placebo	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer Placebo: administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.
OG001	Sodium Nitrite	Subjects will undergo cardiac exercise training and receive inhaled or oral sodium nitrite three times per day for 12 weeks while wearing an accelerometer Sodium Nitrite: administered orally or inhaled, 40 mg, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.

Secondary

Change in Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score

The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a self-administered questionnaire that provides a measure of symptoms and physical limitations associated with heart failure. The overall summary score ranges from 0-100, where the higher the score the better the health status.

Posted

Mean

Standard Deviation

score on a scale

Baseline, 12 weeks

ID	Title	Description
OG000	Placebo	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer Placebo: administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.
OG001	Sodium Nitrite	Subjects will undergo cardiac exercise training and receive inhaled or oral sodium nitrite three times per day for 12 weeks while wearing an accelerometer Sodium Nitrite: administered orally or inhaled, 40 mg, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.

Secondary

Change in Six Minute Walk Test

The six minute walk test is an exercise test used to assess aerobic capacity and endurance. The total distance covered over six minutes is measured in meters.

Posted

Mean

Standard Deviation

meters

Baseline, 12 weeks

ID	Title	Description
OG000	Placebo	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer Placebo: administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.
OG001	Sodium Nitrite	Subjects will undergo cardiac exercise training and receive inhaled or oral sodium nitrite three times per day for 12 weeks while wearing an accelerometer Sodium Nitrite: administered orally or inhaled, 40 mg, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.

Arm/Groups

ID	Title	Description	Deaths (Affected)	Deaths (At Risk)	Serious Events (Affected)	Serious Events (At Risk)	Other Events (Affected)	Other Events (At Risk)
EG000	Placebo	Subjects will undergo cardiac exercise training and receive inhaled or oral placebo three times per day for 12 weeks while wearing an accelerometer Placebo: administered orally or inhaled, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.	0	36	3	36	36	36
EG001	Sodium Nitrite	Subjects will undergo cardiac exercise training and receive inhaled or oral sodium nitrite three times per day for 12 weeks while wearing an accelerometer Sodium Nitrite: administered orally or inhaled, 40 mg, taken every 4 hours or 3 times per day during waking hours for 12 weeks Accelerometer: External triaxial accelerometer is worn externally at the hip during exercise training sessions, and day/night to continuously measure activity levels, removed for bathing only. Cardiac Exercise Training: Cardiac rehabilitation exercise training consisting of supervised endurance and strength exercise training of approximately one hour, 3 times per week for 12 weeks.	0	37	7	37	37	37

Serious Adverse Events

Term	Organ System	Assessment Type	Statistical Information
Severe Chest/Neck/Jaw Pain	Cardiac disorders	Systematic Assessment	EG0001 events1 affected36 at risk EG0012 events2 affected37 at risk
Serious Fall Resulting in Injury	General disorders	Systematic Assessment	EG0001 events1 affected36 at risk EG0010 events0 affected37 at risk
GI Bleed	Gastrointestinal disorders	Systematic Assessment	EG0001 events1 affected36 at risk EG0010 events0 affected37 at risk
Dizziness/Lightheadedness	General disorders	Systematic Assessment	EG0001 events1 affected36 at risk EG0010 events0 affected37 at risk
Shortness of Breath - Worsening Heart Failure	Cardiac disorders	Systematic Assessment	EG0001 events1 affected36 at risk EG0011 events1 affected37 at risk
Pneumonia	Infections and infestations	Systematic Assessment	EG0000 events0 affected36 at risk EG0013 events2 affected37 at risk
Arrhythmia	General disorders	Systematic Assessment	EG0000 events0 affected36 at risk EG0011 events1 affected37 at risk
Syncope/Stent placement	Cardiac disorders	Systematic Assessment	EG0000 events0 affected36 at risk EG0011 events1 affected37 at risk

Other Adverse Events

Term	Organ System	Assessment Type	Statistical Information
Cough	General disorders	Systematic Assessment	EG0008 events7 affected36 at risk EG00112 events10 affected37 at risk
Chest pain	General disorders	Systematic Assessment	EG0009 events8 affected36 at risk EG00114 events11 affected37 at risk
Dizziness	General disorders	Systematic Assessment	EG00019 events14 affected36 at risk EG00130 events22 affected37 at risk
Edema	General disorders	Systematic Assessment	EG0002 events1 affected36 at risk EG0012 events2 affected37 at risk
Fatigue	General disorders	Systematic Assessment	EG00010 events6 affected36 at risk EG0013 events3 affected37 at risk
Upset stomach/diarrhea	Gastrointestinal disorders	Systematic Assessment	EG0006 events5 affected36 at risk EG00116 events12 affected37 at risk
Headache	General disorders	Systematic Assessment	EG0008 events8 affected36 at risk EG00110 events10 affected37 at risk
Cold/SoreThroat/Flu	General disorders	Systematic Assessment	EG00014 events13 affected36 at risk EG00118 events13 affected37 at risk
General Minor Injury - Fall/Bruise/Cut	General disorders	Systematic Assessment	EG0004 events4 affected36 at risk EG0018 events7 affected37 at risk
Miscellaneous - Blister/Bloody nose/Cataract/Dry Mouth/Acne	General disorders	Systematic Assessment	EG00012 events11 affected36 at risk EG00129 events20 affected37 at risk
Nausea	General disorders	Systematic Assessment	EG0008 events6 affected36 at risk EG0016 events5 affected37 at risk
Memory Loss	General disorders	Systematic Assessment	EG0002 events2 affected36 at risk EG0010 events0 affected37 at risk
Numbness/Pins and Needles	General disorders	Systematic Assessment	EG0001 events1 affected36 at risk EG0011 events1 affected37 at risk
Muscle and Joint Pain	Musculoskeletal and connective tissue disorders	Systematic Assessment	EG00014 events11 affected36 at risk EG00117 events15 affected37 at risk
Palpitations	Cardiac disorders	Systematic Assessment	EG0003 events3 affected36 at risk EG0010 events0 affected37 at risk
Mood Changes - Depressed/Edgy/Forgetful	General disorders	Systematic Assessment	EG0004 events4 affected36 at risk EG0012 events2 affected37 at risk
Rash	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0005 events3 affected36 at risk EG0012 events2 affected37 at risk
Shortness of Breath	General disorders	Systematic Assessment	EG0008 events6 affected36 at risk EG00114 events10 affected37 at risk
Bad Taste in Mouth	General disorders	Systematic Assessment	EG0001 events1 affected36 at risk EG0012 events2 affected37 at risk
Weight Gain	General disorders	Systematic Assessment	EG0001 events1 affected36 at risk EG0012 events2 affected37 at risk
Arrhythmia	Cardiac disorders	Systematic Assessment	EG0000 events0 affected36 at risk EG0012 events2 affected37 at risk
Black Stool	Gastrointestinal disorders	Systematic Assessment	EG0000 events0 affected36 at risk EG0011 events1 affected37 at risk
Worsening Renal Function	General disorders	Systematic Assessment	EG0000 events0 affected36 at risk EG0011 events1 affected37 at risk
Revascularization	Cardiac disorders	Systematic Assessment	EG0000 events0 affected36 at risk EG0011 events1 affected37 at risk

Manufacturer discontinuation of the inhaled drug supply forced the investigator to modify the study and change the route of administration of sodium nitrite from inhaled to oral. The oral formulation achieved similar pharmacokinetics and therefore it was scientifically justified to combine the data.

Certain Agreements

ID	Term
D006333	Heart Failure

ID	Term
D012977	Sodium Nitrite
D009573	Nitrites

ID	Term
D006331	Heart Diseases
D002318	Cardiovascular Diseases

ID	Term
D009608	Nitrous Acid
D017672	Nitrogen Compounds
D007287	Inorganic Chemicals
D017670	Sodium Compounds
D000838	Anions
D007477	Ions
D004573	Electrolytes
D009930	Organic Chemicals