Abstract
Background: Oxidative stress is crucial in the pathogenesis of atherosclerosis and acute myocardial infarction (AMI). Under the generic terms “oxidative stress” (OS), many biomarkers belonging to different pathways have been proposed. Aim: To compare the levels of recently proposed OS-related parameters in acute coronary syndromes (ACS) and stable coronary artery disease (CAD), to evaluate their effectiveness as additive risk or illness indicators of stable and acute ischemic events, and their response over time during the course of AMI. Methods: 76 ACS, 77 CAD patients, and 63 controls were enrolled in the study. Different OS-related biomarkers, including reactive oxygen metabolites (ROM), the total antioxidant capacity (OXY), nitrite/nitrate (final nitric oxide products, NOx), and Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), were evaluated. Moreover, time response during AMI course (admission, and 6, 12, 18, 24, 36, and 48 hours after, T0-T6, respectively) and correlation with traditional cardiovascular (CV) risk factors (age, gender, hypertension, diabetes mellitus, dyslipidemia, smoking habit) were also assessed. Results: Over time, ROM progressively increased while OXY and NOx decreased. Kinetics of LOX-1 during AMI shows that this biomarker boosts early during the acute event (T1 and T2) and then progressively decreases, being significantly lower from T0 to T6. Different OS-related biomarkers were differentially associated with CV risk factors and CAD or ACS presence. Conclusion: Differences in OS-related biomarkers (between groups, according to the response over time during AMI, and to the presence of CV risk factors) confirmed OS involvement in the transition from healthy status to stable CAD and ACS, although evidencing the heterogeneous nature of redox processes. In future, a multi-marker panel including different biomarkers and pathways of oxidative stress could be evaluated as an additive tool to be used in the CV prevention, diagnosis, patient stratification, and treatment.
Highlights
IntroductionOxidative stress (increased oxidant generation with impairment of endogenous antioxidant mechanisms) plays an important role in the pathogenesis of atherosclerosis, and it is increased by Antioxidants 2019, 8, 115; doi:10.3390/antiox8050115 www.mdpi.com/journal/antioxidantsAntioxidants 2019, 8, 115 traditional cardiovascular (CV) risk factors (e.g., diabetes mellitus, dyslipidemia, smoking, gender, and age) [1,2,3].Assuming that traditional risk factors explain a large proportion of CV risk, they can be ineffective in some cases, because they are unable to explain why some high-risk patients did not experience a CV event, even in the long term, while a percentage of patients classified as low risk did (e.g., with none or only one of the traditional CV risk factor) [4]
Oxidative stress plays an important role in the pathogenesis of atherosclerosis, and it is increased by Antioxidants 2019, 8, 115; doi:10.3390/antiox8050115 www.mdpi.com/journal/antioxidantsAntioxidants 2019, 8, 115 traditional cardiovascular (CV) risk factors [1,2,3].Assuming that traditional risk factors explain a large proportion of CV risk, they can be ineffective in some cases, because they are unable to explain why some high-risk patients did not experience a CV event, even in the long term, while a percentage of patients classified as low risk did [4]
The present results are in accordance with a number of previous studies highlighting higher oxidative stress status in both stable and acute ischemic disease compared with healthy controls, and the relationship between oxidative stress and presence and number of CV risk factors
Summary
Oxidative stress (increased oxidant generation with impairment of endogenous antioxidant mechanisms) plays an important role in the pathogenesis of atherosclerosis, and it is increased by Antioxidants 2019, 8, 115; doi:10.3390/antiox8050115 www.mdpi.com/journal/antioxidantsAntioxidants 2019, 8, 115 traditional cardiovascular (CV) risk factors (e.g., diabetes mellitus, dyslipidemia, smoking, gender, and age) [1,2,3].Assuming that traditional risk factors explain a large proportion of CV risk, they can be ineffective in some cases, because they are unable to explain why some high-risk patients did not experience a CV event, even in the long term, while a percentage of patients classified as low risk did (e.g., with none or only one of the traditional CV risk factor) [4]. It is important to mention that the discrimination power can be further improved when biomarkers with a low degree of correlation, and as such belonging to independent pathways, reflecting different pathophysiological events, are considered [5] This concept may be true for the oxidative stress, where many oxidative stress-related biomarkers have been proposed, involving both the oxidative and antioxidant counterparts, which reflect the many different pathways that the generic term “oxidative stress” included [4]. Conclusion: Differences in OS-related biomarkers (between groups, according to the response over time during AMI, and to the presence of CV risk factors) confirmed OS involvement in the transition from healthy status to stable CAD and ACS, evidencing the heterogeneous nature of redox processes. A multi-marker panel including different biomarkers and pathways of oxidative stress could be evaluated as an additive tool to be used in the CV prevention, diagnosis, patient stratification, and treatment
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