Fig. 3

Reduced metabolism of nitroglycerin to nitric oxide. The esterase activity for the ALDH2 enzyme is required to convert nitroglycerin to nitric oxide. Those with the ALDH2*2 variant also have a reduction in esterase activity, which in turn causes nitroglycerin to be less efficiently metabolized to nitric oxide. Approximately 40 % more nitroglycerin may need to be given to people with the ALDH2*2 variant to achieve the same effect as those with the ALDH2*1 enzyme