Nitrite, a storage form of NO, can mediate vascular function during pathological conditions when endogenous NO is reduced. The aims of the present study were to characterize the effects of severe MetS and obesity on dyslipidemia, myocardial oxidative stress, and endothelial NO synthase (eNOS) regulation in the obese Ossabaw swine (OS) model and to examine the effects of a novel, sustained-release formulation of sodium nitrite (SR-nitrite) on coronary vascular reactivity and myocardial redox status in obese OS subjected to critical limb ischemia (CLI). After 6 mo of an atherogenic diet, obese OS displayed a MetS phenotype. Obese OS had decreased eNOS functionality and NO bioavailability. In addition, obese OS exhibited increased oxidative stress and a significant reduction in antioxidant enzymes. The efficacy of SR-nitrite therapy was examined in obese OS subjected to CLI. After 3 wk of treatment, SR-nitrite (80 mg·kg Ϫ1 ·day Ϫ1 bid po) increased myocardial nitrite levels and eNOS function. Treatment with SR-nitrite reduced myocardial oxidative stress while increasing myocardial antioxidant capacity. Ex vivo assessment of vascular reactivity of left anterior descending coronary artery segments demonstrated marked improvement in vasoreactivity to sodium nitroprusside but not to substance P and bradykinin in SR-nitrite-treated animals compared with placebo-treated animals. In conclusion, in a clinically relevant, large-animal model of MetS and CLI, treatment with SR-nitrite enhanced myocardial NO bioavailability, attenuated oxidative stress, and improved ex vivo coronary artery vasorelaxation. METABOLIC SYNDROME (MetS) is a multifactorial disease that is characterized by a number of risk factors including obesity, hypertension, dyslipidemia, and hyperglycemia (27). Clinically, MetS is associated with an increased risk for the development of cardiovascular disease. In patients with preexisting atherosclerotic vascular disease, such as peripheral artery disease (PAD), MetS exacerbates vascular damage by impairing vascular endothelial and smooth muscle function (37). Furthermore, PAD patients with MetS have an increased incidence of acute coronary syndromes, resulting in significant cardiovascular morbidity and mortality (5,16,20,21).One of the earliest manifestations of cardiovascular diseases, including PAD, is a loss of endothelial function characterized by dysfunction of endothelial nitric oxide (NO) synthase (eNOS) and reduced NO bioavailability (7,19,44). Our laboratory has recently published data (40) demonstrating significant reductions in circulating NO bioavailability in patients with critical limb ischemia (CLI), a severe manifestation of PAD.Nitrite is recognized as an important physiological storage reservoir of NO in the blood and tissues that protects various organs against ischemic injury (10,12,31). During pathological conditions, nitrite is rapidly reduced to NO to restore NO levels and promote organ homeostasis and survival (10,12,31). Moreover, endogenous nitrite has been shown to exert endocrine a...