Oxidative stress evaluated using an automated method for hydroperoxide estimation in patients with coronary artery disease.

BACKGROUND: Reactive oxygen species (ROS) play a major role in the pathogenesis of different chronic and degenerative diseases, including atherosclerosis. However, the lack of feasible and reliable methods limits the spread of oxidative stress estimation for routine application in clinical chemistry laboratories. We have recently evaluated the analytical characteristics of an automated test for the measurement of hydroperoxides (HPs) and its performance in determining oxidative stress levels in a general population. In this study we applied this method for the evaluation of oxidative stress in a cohort of patients with coronary artery disease (CAD). METHODS: A total of 69 patients with angiographically verified CAD and 34 age- and sex-matched control subjects were enrolled in the study. RESULTS: HPs were higher in patients with CAD (p<0.01), significantly increasing with disease severity (p<0.01). HPs were also higher in subjects with diabetes, dyslipidemia or C-reactive protein >1.5mg/L. A significant positive correlation was observed between glucose and HP levels. In a multivariate model, diabetes (odds ratio OR=3.5, 95% CI 1.2-10, p<0.05) and CAD (OR=5.7, CI 1.1-28.5, p<0.05) were independent determinants for the 75th HP percentile. CONCLUSIONS: The results obtained with this method largely reproduce those found using other oxidative stress biomarkers, but the method is faster, easy to perform and does not require skilled operators or complex instrumentation, and thus is a reliable procedure that might represent a feasible tool for oxidative stress estimation in the cardiovascular setting.     

Waist-to-hip ratio correlates with homocysteine levels in male patients with coronary artery disease

BACKGROUND: Obesity and homocysteine are important risk factors for cardiovascular disease. The relation between pattern of obesity and homocysteine is unclear. The objective of this study was to investigate the relation between pattern of obesity and plasma total homocysteine (tHcy) level in male patients with coronary artery disease (CAD). METHODS: A total of 63 male patients (mean age 66.2 years) with angiographically documented CAD were enrolled. Overnight fasting blood samples were measured for plasma tHcy, serum folic acid and serum vitamin B12 levels. Anthropometric measurements included waist-to-hip ratio (WHR) and body mass index (BMI). RESULTS: The mean WHR was 0.90+/-0.05, mean BMI 24.6+/-3.3 kg/m2 and the mean plasma tHcy level 11.6+/-3.2 micromol/L. In univariate analysis, plasma tHcy level correlated significantly with serum vitamin B12 level, serum folic acid level, WHR, estimated creatinine clearance, aspirin use and fibrate use. There was no significant association between plasma tHcy level and BMI. In multivariate analysis, only WHR (beta-value 22.263, p<0.001), serum level of vitamin B12 (beta-value -0.004, p=0.003), estimated creatinine clearance (beta-value -4.154, p=0.003) and use of fibrates (beta-value 2.307, p=0.031) were independent predictors of plasma tHcy level. CONCLUSIONS: WHR, but not BMI, is a strong independent predictor of plasma tHcy level in male patients with CAD.     

吸烟对冠心病患者血浆同型半胱氨酸的影响

目的探讨吸烟对冠心病患者血浆同型半胱氨酸（HCY）的影响,为冠心病患者早期治疗提供依据。方法将所有研究对象分为4组：①冠心病吸烟组74例;②冠心痛不吸烟组46例;③健康吸烟组42例;④健康不吸烟组26例。又根据吸烟指数将所有入选的吸烟者分成3组：重度吸烟组40例、中度吸烟组44例和轻度吸烟组32例。采用酶联免疫吸附测定（ELISA）法检测血浆HCY水平。结果血浆HCY水平在冠心病吸烟组、冠心病不吸烟组、健康吸烟组、健康不吸烟组中依次降低（15．79±4．18）μmol／L、（12．12±2．43）μmol／L、（10．85±3．78）μmol／L、（7．26±3．15）μmol／L（P〈0．01）,在健康不吸烟组、轻度吸烟组、中度吸烟组、重度吸烟组血浆HCY水平依次增高（7．26±3．15）μmol／L、（9．58±4．06）μmol／L、（13．32±3．26）μmol／L、（15．43±3．18）μmol／L（P〈0．01）。结论吸烟使冠心病患者和健康者血浆HCY水平升高,HCY水平随吸烟指数的增加而升高。     

血清糖化白蛋白和同型半胱氨酸与冠状动脉病变的相关性

目的 探讨冠状动脉病变程度与血清糖化白蛋白（glycated albumin,GA）、同型半胱氨酸（homocysteine,Hcy）的关系及临床意义。方法 行冠状动脉造影检查患者151例,依据检查结果分为冠心病组121例和非冠心病组30例,冠心病组根据病变血管支数、Gensini积分、SYNTAX积分分为不同亚组,分析冠心病组和非冠心病组、冠心病不同亚组GA、Hcy水平差异。结果 冠心病组血清GA、Hcy、高密度脂蛋白胆固醇、陈旧性心肌梗死构成比分别为（15.38±3.68）%、（15.55±7.23）μmol/L、（0.93±0.22）mmol/L、18.2%,非冠心病组分别为（13.88±2.0）%、（12.73±4.42）μmol/L、（1.06±0.21）mmol/L、3.3%,2组比较差异有统计学意义（P〈0.05）;不同病变血管支数冠心病患者GA、Hcy水平比较差异无统计学意义（P〉0.05）;冠心病组Gensini积分、SYNTAX积分与血清GA、Hcy水平呈正相关（r值为0.4969~0.6731,P〈0.05）。结论 GA与Hcy联合检测对冠状动脉病变程度有预测价值。     

Association of plasma homocysteine with coronary artery calcification in different categories of coronary heart disease risk

OBJECTIVE: To Investigate the association of plasma homocystelne with coronary artery calcification (CAC) in strata based on 10-year risk of coronary heart disease (CHD) in a cohort enriched in persons with hypertension. PARTICIPANTS AND METHODS: Fasting plasma homocystelne was measured by liquid chromatography electrospray tandem mass spectrometry. Coronary artery calcification was measured noninvasively by electron beam computed tomography and CAC score calculated using the method of Agatston et al. The 10-year CHD risk was calculated based on the Framingham risk score. The association of homocysteine with log-transformed CAC score was assessed in the pooled sample and within each risk stratum by linear regression after adjustment for conventional risk factors. RESULTS: In the 1071 participants studied, homocysteine was associated with CAC quantity (P = .01) after adjustment for CHD risk factors (age, male sex, total and high-density lipoproteln cholesterol, diabetes, history of smoking, body mass Index, and systolic blood pressure), serum creatinine, and statin and hypertension medication use. When the association was assessed in strata based on 10-year CHD risk, homocysteine was significantly (P = .003) associated with CAC quantity in participants at Intermediate 10-year risk of CHD (6%-20%) independent of other risk factors but not in those at lower risk or higher risk. CONCLUSION: Plasma homocysteine is associated with quantity of CAC Independent of CHD risk factors. When studied in categories of 10-year CHD risk, the association was significant in participants at intermediate risk but not in those at low or high risk. Plasma homocysteine levels may have clinical utility as a marker of CHD risk in such individuals.     

氧化应激与阿尔茨海默病

目的：探时氧化心激在阿尔茨海默病发生发展中的作用，了解褪黑素防治阿尔茨海默病的现状。方法：分析了近年研究的有关阿尔茨海默病氧化损伤证据和可能机制，以及褪黑素用于阿尔茨海默病治疗的研究现状。结果：阿尔茨海默病3种主要病理变化-老年斑、神经纤维缠结、神经元死亡都有自由基参与，因此外源性抗氧化剂的应用是阿尔茨海默病药物治疗的有前途的一种方法。褪黑素是松果体腺分泌的主要激素，具有抗自由基和保护神经元的作用，其延缓衰老的作用已明确，并且褪黑素在阿尔茨海默病患者体内水平降低也被证实。结论：氧化应激在阿尔茨海默病发病上起重要作用。褪黑素具有强大的抗自由基作用，但外源性补充褪黑素究竟能否起到预防或减轻阿尔茨海默病的发病及进展需要进一步证实。     

氧化应激与阿尔茨海默病

目的:探讨氧化应激在阿尔茨海默病发生发展中的作用,了解褪黑素防治阿尔茨海默病的现状。方法:分析了近年研究的有关阿尔茨海默病氧化损伤证据和可能机制,以及褪黑素用于阿尔茨海默病治疗的研究现状。结果:阿尔茨海默病3种主要病理变化-老年斑、神经纤维缠结、神经元死亡都有自由基参与,因此外源性抗氧化剂的应用是阿尔茨海默病药物治疗的有前途的一种方法。褪黑素是松果体腺分泌的主要激素,具有抗自由基和保护神经元的作用,其延缓衰老的作用已明确,并且褪黑素在阿尔茨海默病患者体内水平降低也被证实。结论:氧化应激在阿尔茨海默病发病上起重要作用。褪黑素具有强大的抗自由基作用,但外源性补充褪黑素究竟能否起到预防或减轻阿尔茨海默病的发病及进展需要进一步证实。     

运动训练对冠心病患者血浆同型半胱氨酸水平的影响

目的探讨运动训练对冠心病患者血浆同型半胱氨酸（Hey）水平的影响。方法将148例冠心病患者分为康复组81例及药物组67例，均给予基础药物治疗和冠心病饮食指导，康复组患者增加运动训练；药物组同时应用叶酸、维生素B。：治疗。结果经12周的治疗，2组Hey水平均明显低于治疗前（P〈0．05）；组间比较，差异无统计学意义（P〉0．05）。康复组心功能及生活质量方面较药物组有明显改善（P〈0．05）。结论心脏康复治疗可明显降低冠心病患者Hey水平，改善心功能状态，提高患者生活质量。     

血浆同型半胱氨酸水平与早发冠心病患者冠脉病变特点的相关性分析

目的分析血浆同型半胱氨酸(Hcy)水平与早发冠心病患者冠脉病变特点的相关性。方法将209例早发冠心病患者设为早发冠心病组,同时选取100例非早发冠心病患者做对照组。根据冠脉病变支数将早发冠心病组分为单支病变组、双支病变组、三支病变组。分析早发冠心病患者的病变程度与Hcy水平的相关性。结果早发冠心病组血浆Hcy水平高于对照组(P<0.05)。早发冠心病组三个亚组的血浆Hcy水平随着病变累及支数增加呈上升趋势(P<0.05)。早发冠心病组的冠脉病变程度与血浆Hcy水平呈正相关(P<0.01)。结论早发型冠心病患者的血浆Hcy水平与其冠状动脉血管病变严重程度呈正相关。     

Oxidative stress and mitochondrial damage in coronary artery bypass graft surgery: Effects of antioxidant treatments

We examined antioxidant actions in 73 patients undergoing coronary artery surgery by assessing mitochondrial damage and oxidative stress in ventricular biopsies obtained at preischemia and postreperfusion. Those patients who received antioxidant therapy benefited by less oxidative stress and mitochondrial damage.     

Oxidative stress and mitochondrial damage in coronary artery bypass graft surgery: Effects of antioxidant treatments

We examined antioxidant actions in 73 patients undergoing coronary artery surgery by assessing mitochondrial damage and oxidative stress in ventricular biopsies obtained at preischemia and postreperfusion. Those patients who received antioxidant therapy benefited by less oxidative stress and mitochondrial damage.     

血浆同型半胱氨酸水平对女性高血压患者冠状动脉病变的预测价值

目的探讨血浆同型半胱氨酸(Hcy)水平对女性高血压患者冠状动脉病变的预测价值。 方法回顾性分析2018年6月至2020年9月在成都市温江区人民医院行冠状动脉检查的原发性高血压女性患者231例,收集患者入院时实验室指标。根据冠状动脉病变SYNTAX评分,将患者分为冠状动脉正常组(n＝163)与冠状动脉病变组(n＝68),比较两组患者上述各指标,并采用多因素Logistic回归分析各因素对患者冠状动脉病变的影响,并以受试者工作特征(ROC)曲线判断各指标对冠状动脉病变的预测价值。 结果各指标中,冠状动脉病变组与正常组中年龄[(65.82±5.88)岁,(62.09±4.92)岁]、白细胞计数[(6.82±1.54)×10⁹/L,(5.73±1.09)×10⁹/L]、中性粒细胞计数[(4.71±1.29)×10⁹/L,(3.88±0.84)×10⁹/L]、低密度脂蛋白胆固醇水平[(3.24±0.42)mmol/L,(2.75±0.51)mmol/L]、同型半胱氨酸水平[(32.05±6.83)μmol/L,(14.27±3.84)μmol/L]比较,均差异有统计学意义(t＝4.95,6.10,5.79,6.99,25.10;均P<0.01)。多因素Logistic回归分析结果显示,低密度脂蛋白胆固醇[OR＝1.449,95%CI(1.016~2.066)]及Hcy[OR＝1.493,95%CI(1.064~2.096)]水平升高为女性高血压患者冠状动脉病变的危险因素(均P<0.05)。ROC曲线分析结果显示,低密度脂蛋白胆固醇及Hcy预测的截断值分别为2.96 mmol/L、25.03 μmol/L;曲线下面积(AUC)分别为0.650,0.796;两者联合诊断的AUC为0.879,其诊断效能高于各单独指标(Z＝4.26,4.72;均P<0.05)。 结论低密度脂蛋白胆固醇及Hcy水平升高为女性高血压患者冠状动脉病变的危险因素,两者联合检测可有效提高冠状动脉病变的预测效果。     

Plasma homocysteine: an independent or an interactive risk factor for coronary artery disease

BACKGROUND: Coronary artery disease (CAD) is emerging as a major public health concern in most developing countries. Further conventional risk factors for CAD do not solely account for the increased mortality, particularly in Asians. Recently, increased plasma homocysteine is being considered as a risk factor, but the strength of relationship and interaction of plasma homocysteine with other risk factors is yet obscure. In this study, the association of plasma homocysteine with CAD and other risk factors was estimated. METHODS: In the present study, 100 patients of CAD and 50 controls of both sexes were included. Plasma total homocysteine (tHcy) concentrations were measured using reverse phase high-performance liquid chromatography. RESULTS: Plasma homocysteine concentrations were significantly raised in cases as compared to age-matched controls (16.57+/-6.86 and 11.47+/-5.19 micromol/l, p<0.001). On calculating relative risk (RR) of each factor by univariate analysis smoking, hypertension, plasma cholesterol and homocysteine appeared to be significant risk factors. However, on applying multiple logistic regression only the latter three emerged as independent risk factors (p<0.005). Further, strong interactive effects were observed between homocysteine levels and increasing age, hypertension and smoking. CONCLUSION: An increase in plasma homocysteine concentration confers an independent risk for CAD. It further increases the risk associated with increasing age, smoking and hypertension. Thus, increased homocysteine concentrations are a significant medical problem and effective strategies are urgently required to counter this challenge.     

Correlation of oxidative stress parameters and inflammatory markers in coronary artery disease patients

OBJECTIVES: In addition to many traditional risk factors for coronary artery disease (CAD) development, enhanced oxidative stress and inflammation are serious conditions that may also be classified as novel risk factors. In the present study, we assessed the relationship between several parameters of oxidative stress status [malonaldehyde (MDA), superoxide anion (O(2)(-)) and plasma and erythrocyte superoxide dismutase (SOD) activities] with high sensitivity C-reactive protein (hsCRP) and fibrinogen as inflammation markers. DESIGN AND METHODS: Oxidative stress status parameters, inflammation markers and lipid status parameters were measured in 385 subjects [188 coronary heart disease (CHD) patients with angiographically diagnosed coronary artery disease (CAD), 141 patients with occlusion >50% in at least one major coronary artery (CAD+) and 47 patients with occlusion less than 50% (CAD-), and 197 CHD-free middle-aged subjects (the control group)]. RESULTS: The plasma MDA concentration and the level of O(2)(-) in plasma were significantly higher in combination with significantly lower SOD activity in the CAD+ group vs. the control group. By using multiple stepwise regression analysis, fibrinogen and hsCRP showed independent correlation with MDA. Binary logistic regression analysis indicated that both MDA and O(2)(-) were significantly associated with CAD development and adjustment for inflammatory markers weakened this association in the case of MDA. CONCLUSIONS: The relationship between oxidative stress parameters and inflammatory species suggest their strong mutual involvement in atherosclerosis development that leads to CAD progression.     

Oxidative injury and antioxidants in coronary artery bypass graft surgery: off-pump CABG significantly reduces oxidative stress

BACKGROUND: Coronary artery bypass grafting (CABG) can now be performed with or without cardiopulmonary bypass. The former entails global ischemia followed by reperfusion after declamping, whereas the latter does not. In view of growing evidence that reperfusion is associated with oxidative stress, we studied the extent of oxidative stress and antioxidant status in patients undergoing on-pump and off-pump CABG to determine whether the latter significantly reduces oxidative stress. METHODS: Thirty patients were initially enrolled for the study. The inclusion criteria included patients with atherosclerotic triple vessel disease, undergoing elective CABG, with good LV function, no major risk factors for surgery, with all biochemical investigations within normal limits, having stable angina and no history of previous infarct. Patients with valvular heart disease, ventricular aneurysm, heart failure and poor left ventricular function were excluded. These were alternately posted for on-pump and off-pump CABG. Eight patients were excluded as they developed unforeseen complications during the surgery. Out of the remaining 22 patients, 13 underwent off-pump CABG and 9 underwent on-pump CABG. Five blood samples were collected; baseline, 5, 15, 60 min and 24 h after reperfusion. Samples were analyzed for thiobarbituric acid reactive substances (TBARS), glutathione (G-SH) and catalase (CAT). The results were compared with their preanaesthetic levels in both the groups and also with 20 age- and sex-matched normal healthy individuals. RESULTS: Lipid peroxidation was significantly increased after reperfusion in patients undergoing on-pump CABG, maximum increase (p<0.0001) was seen 1 h after reperfusion, whereas off-pump CABG reduces oxidative stress. The G-SH levels were significantly decreased after reperfusion in on-pump and off-pump CABG patients, maximum decrease (p<0.0001) was seen 5 min after reperfusion in on-pump CABG. The catalase activity was significantly increased after reperfusion in on-pump and off-pump CABG patients, maximum increase (p<0.0001) was seen 1 h after reperfusion in on-pump CABG. CONCLUSION: Significant increase in oxidative stress was seen in patients undergoing on-pump CABG, whereas oxidative stress was less in off-pump CABG patients. The G-SH levels were decreased and Catalase activity was increased significantly in both on-pump and off-pump CABG patients.     

Using physiologic and pharmacologic stress testing in the evaluation of coronary artery disease

Evaluating and treating coronary artery disease (CAD), the leading cause of death in the United States, are priorities for primary care practitioners. Stress testing is a noninvasive, cost-effective technique to help diagnose CAD and evaluate its extent. The test can also be used to clarify the etiology of chest pain, evaluate a medical regimen, identify arrhythmias, risk-stratify patients preoperatively, and determine exercise tolerance. Myocardial perfusion imaging and echocardiography can increase the test's sensitivity and specificity. Pharmacologic testing is available to evaluate patients who are unable to exercise adequately. Test selection is based on the patient's ability to exercise, concurrent illnesses (for example, reactive airway disease), and desired findings. The evaluation of results should be based on history and the pretest probability of cardiovascular disease. A cardiologist should evaluate any results that fall to correlate with the patient's presentation or pretest likelihood of disease for possible coronary angiography.