Written by Chrystal Moulton, Science Writer. Researchers observed a significant decrease in pulse wave velocity, beta stiffness, augmentation index, while arterial compliance increased significantly by week 12 in the nitrate rich group.

Post menopausal women are generally at higher risk of cardiovascular events due to a reduction in nitric oxide bioavailability and a decrease in estrogen^1-3. Central and carotid arterial stiffness, which is used to measure cardiovascular disease risk, is higher in postmenopausal women compared to premenopausal women⁴.  Supplementation with dietary nitrate has demonstrated mixed results with short term supplementation showing no benefit^5,6. However, long term supplementation with dietary nitrate demonstrated positive results⁷. In the current study, researchers investigated the long-term effect of dietary nitrate intake on carotid artery stiffness in post-menopausal women⁸.

The study was designed as a randomized, placebo-controlled, double-blind, parallel study. Participants between the age of 60 and 85 years old were recruited and randomly assigned to receive either nitrate rich beetroot extract or nitrate depleted beetroot extract. Individuals with neurological disease, a history of heart attack, uncontrolled hypertension, heart failure, undergoing estrogen replacement therapy, or cancer were not eligible for this trial. Eligible subjects were required to take their assigned protocol for 12 weeks. Lab tests were conducted at baseline and at weeks 4, 8, and 12. Carotid artery stiffness was measured using high-definition ultrasound. Blood samples collected at weeks 4, 8, and 12 were used to assess serum nitrate and nitrite levels. Participants were told not to consume spinach, arugula, or beetroot as well as using mouthwash during the study period.

A total of 20 post-menopausal women between 65 and 80 years old participated in this trial. Total cholesterol and LDL-C was significantly higher in the nitrate rich group compared to the nitrate depleted group (P <0.05). No other significant differences were observed between the groups. Researchers observed a significant decrease in pulse wave velocity, beta stiffness, augmentation index, while arterial compliance increased significantly by week 12 in the nitrate rich group. See table below for details. No significant changes in blood pressure and mean arterial pressure were observed over the 12-week study between groups. No significant differences were observed in the nitrate depleted group at the end of the study. Additional analysis revealed that serum nitrate levels significantly increased in the nitrate rich group at weeks 4, 8, and 12 compared to the nitrate depleted group. Serum nitrite levels were also significantly increased in the nitrate rich group at weeks 8 and 12 compared to the nitrate depleted group.

Table 1. Results of 12-week dietary nitrate supplementation

P-values compared to nitrate-depleted group. ­ indicates increase, ¯ decrease. PWV pulse wave velocity.

Results from this trial show that 12-week supplementation with dietary nitrate significantly improved measures of carotid artery stiffness [i.e. Beta-stiffness, pressure strain elastic modulus, pulse wave velocity, augmentation index, and arterial compliance]. Researchers also observed a significant improvement in serum nitrate and nitrite after nitrate supplementation by week 12. Additional studies will be needed to verify these findings.

Source: Pinheiro, Vivian dos Santos, David N. Proctor, Rogerio Nogueira Soares, and Thiago Silveira Alvares. “Effect of 12-wk dietary nitrate supplementation on carotid arterial stiffness in postmenopausal females.” American Journal of Physiology-Heart and Circulatory Physiology 328, no. 4 (2025): H937-H944.

© 2025 The Authors. Licensed under Creative Commons Attribution CC-BY 4.0.

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Posted August 12, 2025.

Chrystal is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Chicago.

References:

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8. Pinheiro VDS, Proctor DN, Nogueira Soares R, Alvares TS. Effect of 12-wk dietary nitrate supplementation on carotid arterial stiffness in postmenopausal females. Am J Physiol Heart Circ Physiol. Apr 1 2025;328(4):H937-h944. doi:10.1152/ajpheart.00065.2025