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Current Nutrition & Food Science

Editor-in-Chief

ISSN (Print): 1573-4013
ISSN (Online): 2212-3881

Clinical Trial

The Effect of Vitamin C Supplementation on Cardiac Enzymes After Coronary Artery Bypass Graft: A Double-blind Randomized Control Trial

Author(s): Jalal Moludi, Mohammad Alizadeh, Godarz Chehri, Hamed Jafari-Vayghyan, Elaheh Foroumandi, Vahid Maleki, Behzad Ebrahimi, Anita Sadeghpour, Azin Alizadehasl and Ali S. Tabaee*

Volume 16, Issue 5, 2020

Page: [833 - 838] Pages: 6

DOI: 10.2174/1573401315666190712213051

Price: $65

Abstract

Background: Coronary artery bypass graft (CABG) is associated with oxidative stress and tissue damage. Vitamin C, as an antioxidant agent, has an important role in attenuating the oxidative stress damage and might have cardio-protective effects after CABG. We aimed to evaluate the probable roles of vitamin C supplementation in cardiac biomarkers after CABG.

Methods: In this randomized control trial, 122 patients undergoing CABG were randomly assigned to the intervention (n=54) and control group (n=68) and received vitamin C (2 g intravenously) or placebo, respectively. The surgical methods of the patients in the two groups were identical. The primary efficacy endpoint of this trial is the difference in the levels of CK-MB, Troponin and Total Antioxidant Capacity (TAC) were measured at study entry and 24 hrs after surgery between the two groups.

Results: The two groups were not significantly different in terms of basic variables. Within-group comparison showed significant rises in the level of troponin (P < 0.001) and CK-MB (P < 0.001) over time. However, between-group comparison showed no significant difference between the two groups in terms of CK-MB (P=0.826) and troponin (P=0.821). As a whole, the correlation between cardiac enzymes and surgical characteristic was not seen.

Conclusion: The results showed that pretreatment with vitamin C could not reduce cardiac marker following CABG. After the intervention, TAC did not differ between and within the intervention and the control groups. Pretreatment with vitamin C as an antioxidant agent could not reduce ischemicreperfusion resulting in CABG.

Keywords: Antioxidant, CABG, CKMB, reperfusion, troponin, vitamin C.

Graphical Abstract
[1]
Moludi J, Alizadeh M, Davari M, Golmohammadi A, Maleki V. The efficacy and safety of probiotics intervention in attenuating cardiac remodeling following myocardial infraction: Literature review and study protocol for a randomized, double-blinded, placebo controlled trial. Contemp Clin Trials Commun 2019; 15, 100364
[http://dx.doi.org/10.1016/j.conctc.2019.100364]
[2]
Luyten CR, van Overveld FJ, De Backer LA, et al. Antioxidant defence during cardiopulmonary bypass surgery. Eur J Cardiothorac Surg 2005; 27(4): 611-6.
[http://dx.doi.org/10.1016/j.ejcts.2004.12.013] [PMID: 15784359]
[3]
McColl AJ, et al. Plasma antioxidants: evidence for a protective role against reactive oxygen species following cardiac surgery. Ann Clin Biochem 1998; 35(5): 616-23.
[http://dx.doi.org/10.1177/000456329803500504]
[4]
Milei J, Forcada P, Fraga CG, et al. Relationship between oxidative stress, lipid peroxidation, and ultrastructural damage in patients with coronary artery disease undergoing cardioplegic arrest/reperfusion. Cardiovasc Res 2007; 73(4): 710-9.
[http://dx.doi.org/10.1016/j.cardiores.2006.12.007] [PMID: 17224138]
[5]
Dehaki MG, Tabaee AS, Ahmadabadi CA, Ghavidel AA, Omra G. Pulmonary artery banding in the current era: Is it still useful? Annals of pediatric cardiology 2012; 5(1): 36.
[http://dx.doi.org/10.4103/0974-2069.93708] [PMID: 22529599]
[6]
Orhan G, et al. Systemic and myocardial inflammation. Tex Heart Inst J 2007; 34: 160-5.
[7]
Moludi J, Alizadeh M, Lotfi Yagin N, et al. New insights on atherosclerosis: A cross-talk between endocannabinoid systems with gut microbiota. J Cardiovasc Thorac Res 2018; 10(3): 129-37.
[http://dx.doi.org/10.15171/jcvtr.2018.21] [PMID: 30386532]
[8]
Zhao Z-Q, Corvera JS, Halkos ME, et al. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol 2003; 285(2): H579-88.
[http://dx.doi.org/10.1152/ajpheart.01064.2002] [PMID: 12860564]
[9]
Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol 2003; 42(9): 1547-54.
[http://dx.doi.org/10.1016/j.jacc.2003.05.001] [PMID: 14607436]
[10]
Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol 2003; 42(9): 1547-54.
[http://dx.doi.org/10.1016/j.jacc.2003.05.001] [PMID: 14607436]
[11]
Foroughinia F, Salamzadeh J, Namazi MH. Protection from procedural myocardial injury by omega-3 polyunsaturated fatty acids (PUFAs): is related with lower levels of creatine kinase-MB (CK-MB) and troponin I? Cardiovasc Ther 2013; 31(5): 268-73.
[http://dx.doi.org/10.1111/1755-5922.12016] [PMID: 23134549]
[12]
Moludi J, Keshavarz S, Tabaee AS, Safiri S, Pakzad R. Q10 supplementation effects on cardiac enzyme CK-MB and troponin in patients undergoing coronary artery bypass graft: a randomized, double-blinded, placebo-controlled clinical trial. J Cardiovasc Thorac Res 2016; 8(1): 1-7.
[http://dx.doi.org/10.15171/jcvtr.2016.01] [PMID: 27069560]
[13]
Sadeghpour Anita, et al. Impact of vitamin C supplementation on post-cardiac surgery ICU and hospital length of stay. Anesthesiology and pain medicine 2015.
[http://dx.doi.org/10.5812/aapm.25337]
[14]
Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000; 36(3): 959-69.
[http://dx.doi.org/10.1016/S0735-1097(00)00804-4] [PMID: 10987628]
[15]
Carrier M, Pellerin M, Perrault LP, Solymoss BC, Pelletier LC. Troponin levels in patients with myocardial infarction after coronary artery bypass grafting. Ann Thorac Surg 2000; 69(2): 435-40.
[http://dx.doi.org/10.1016/S0003-4975(99)01294-1] [PMID: 10735677]
[16]
Kathiresan S, Servoss SJ, Newell JB, et al. Cardiac troponin T elevation after coronary artery bypass grafting is associated with increased one-year mortality. Am J Cardiol 2004; 94(7): 879-81.
[http://dx.doi.org/10.1016/j.amjcard.2004.06.022] [PMID: 15464669]
[17]
Farah R, Shurtz-Swirski R, Bolotin Y, Brezins M. Oxidative stress and inflammation due to peripheral polymorphonuclear leukocytes after coronary angiography vs percutaneous coronary intervention. Minerva Cardioangiol 2008; 56(2): 189-95.
[PMID: 18319697]
[18]
Weisel RD, Mickle DA, Finkle CD, et al. Myocardial free-radical injury after cardioplegia. Circulation 1989; 80(5 Pt 2): III14-8.
[PMID: 2805294]
[19]
Wang ZJ, Hu WK, Liu YY, et al. The effect of intravenous vitamin C infusion on periprocedural myocardial injury for patients undergoing elective percutaneous coronary intervention. Can J Cardiol 2014; 30(1): 96-101.
[http://dx.doi.org/10.1016/j.cjca.2013.08.018] [PMID: 24365194]
[20]
Basili S, Tanzilli G, Mangieri E, et al. Intravenous ascorbic acid infusion improves myocardial perfusion grade during elective percutaneous coronary intervention: relationship with oxidative stress markers. JACC Cardiovasc Interv 2010; 3(2): 221-9.
[http://dx.doi.org/10.1016/j.jcin.2009.10.025] [PMID: 20170881]
[21]
De Paulis R, Penta De Peppo A, Colagrande L, et al. Troponin I release after CABG surgery using two different strategies of myocardial protection and systemic perfusion. J Cardiovasc Surg (Torino) 2002; 43(2): 153-9.
[PMID: 11887047]
[22]
Siracusano L, Girasole V. Sevoflurane and cardioprotection. Br J Anaesth 2008; 100(2): 278-9.
[http://dx.doi.org/10.1093/bja/aem381] [PMID: 18212000]
[23]
Blankstein R, Ward RP, Arnsdorf M, Jones B, Lou YB, Pine M. Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 Midwestern hospitals. Circulation 2005; 112(9)(Suppl.): I323-7.
[PMID: 16159840]
[24]
Baggish AL, MacGillivray TE, Hoffman W, et al. Postoperative troponin-T predicts prolonged intensive care unit length of stay following cardiac surgery. Crit Care Med 2004; 32(9): 1866-71.
[http://dx.doi.org/10.1097/01.CCM.0000139692.19371.7C] [PMID: 15343014]
[25]
Lim W, Cook DJ, Griffith LE, Crowther MA, Devereaux PJ. Elevated cardiac troponin levels in critically ill patients: prevalence, incidence, and outcomes. Am J Crit Care 2006; 15(3): 280-8.
[PMID: 16632770]
[26]
Hein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. Prolonged intensive care unit stay in cardiac surgery: risk factors and long-term-survival. Ann Thorac Surg 2006; 81(3): 880-5.
[http://dx.doi.org/10.1016/j.athoracsur.2005.09.077] [PMID: 16488688]
[27]
Westhuyzen J, Cochrane AD, Tesar PJ, et al. Effect of preoperative supplementation with α-tocopherol and ascorbic acid on myocardial injury in patients undergoing cardiac operations. J Thorac Cardiovasc Surg 1997; 113(5): 942-8.
[http://dx.doi.org/10.1016/S0022-5223(97)70268-X] [PMID: 9159629]
[28]
Kjellman UW, Björk K, Ekroth R, et al. Addition of α-ketoglutarate to blood cardioplegia improves cardioprotection. Ann Thorac Surg 1997; 63(6): 1625-33.
[http://dx.doi.org/10.1016/S0003-4975(97)00213-0] [PMID: 9205160]

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