Abstract
Over 240 million non-cardiac operations occur each year and are associated with a 15–20% incidence of adverse perioperative cardiovascular events. Unfortunately, preoperative therapies that have been useful for chronic ischemic heart diseases, such as coronary artery revascularization, antiplatelet agents, and beta-blockers have failed to improve outcomes. In a pre-clinical swine model of ischemic heart disease, we showed that daily administration of ubiquinone (coenzyme Q10, CoQ10) enhances the antioxidant status of mitochondria within chronically ischemic heart tissue, potentially via a PGC1α-dependent mechanism. In a randomized controlled trial, among high-risk patients undergoing elective vascular surgery, we showed that NT Pro-BNP levels are an important means of risk-stratification during the perioperative period and can be lowered with administration of CoQ10 (400 mg/day) for 3 days prior to surgery. The review provides background information for the role of oxidant stress and inflammation during high-risk operations and the potential novel application of ubiquinone as a preoperative antioxidant therapy that might reduce perioperative adverse cardiovascular outcomes.
Highlights
It has been estimated that over 240 million major non-cardiac surgical procedures are scheduled each year, with at least 1 in 6 suffering from adverse events that occur during those surgeries including a 30-day risk of either death or significant cardiovascular complication [1,2]
In a randomized controlled study involving over 500 veterans undergoing elective vascular surgery and 20 medical centers within the Veterans Affair (VA) health care system, we demonstrated that a strategy of preoperative coronary artery revascularization before an elective vascular surgery did not reduce the long-term risk of death at 2.7 years following the operation [4]
In a sub-study of our trial, termed the coronary artery revascularization prophylaxis (CARP) trial, we showed that the incidence of elevated cardiac troponin following surgery was not reduced with preoperative coronary artery revascularization, yet was a powerful predictor of long-term risk of adverse outcomes [9]
Summary
It has been estimated that over 240 million major non-cardiac surgical procedures are scheduled each year, with at least 1 in 6 suffering from adverse events that occur during those surgeries including a 30-day risk of either death or significant cardiovascular complication [1,2]. Other randomized controlled trials have tried to reduce adverse perioperative outcomes and have targeted well-accepted risk factors among patients undergoing elective surgery, including pharmacological agents that are known to reduce secondary outcome measures in patients with coronary artery disease They have not consistently shown that the incidence of postoperative adverse cardiovascular events can be mitigated [6,7,8]. In a sub-study of our trial, termed the coronary artery revascularization prophylaxis (CARP) trial, we showed that the incidence of elevated cardiac troponin following surgery was not reduced with preoperative coronary artery revascularization, yet was a powerful predictor of long-term risk of adverse outcomes [9] These data are consistent with other trials [10,11] and emphasize the important fact that cardiac troponins provide incremental value in post-operative risk-stratification [12]. The focus of our review is to gather relevant references in perioperative medicine as well as on the potential value in the application of ubiquinone by using a search system that encompasses basic and translational sciences, as defined by approaches recommended and outlined by the PRISMA guidelines
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
