Abstract
Despite advances in the management of cardiovascular diseases, acute coronary syndrome (ACS) remains the leading cause of death worldwide. ACS is associated with an imbalance between coronary blood supply and metabolic requirements. Lipid peroxidation and production of reactive oxygen species (ROS) damage the cardiac cell membrane. A total of 130 subjects, 65 ACS patients (45 with ST segment elevation (STE-ACS), 20 non-STE-ACS), and 65 healthy controls were recruited. Measurement of serum zinc, total antioxidant capacity (TAC) and malondialdehyde (MDA) by spectrophotometric methods 24 h after onset of ACS, and relations between the studied biochemical parameters and risk factors were performed. MDA levels were significantly increased; TAC and zinc levels were significantly decreased in ACS patients compared to the controls (P < 0.001 for each). No significant difference was detected between the different types of ACS and each of the oxidative stress parameters, cardiac biomarkers, lipogram, and risk factors. Only serum zinc in STE-ACS patients was significantly lower compared with NSTE-ACS patients (P < 0.001). Serum zinc showed the greatest AUC (area under the ROC curve) of 0.926 with 76.92% sensitivity and 95.38% specificity. Negative and positive correlations between MDA and zinc and between TAC and zinc levels respectively (P < 0.01) were found in ACS. Week negative correlation was observed between serum zinc and SYNTAX score (r = − 0.434, P = 0.049). Our results indicate that deficient serum zinc concentration strongly associated with the etiopathogenesis of ACS.
Similar content being viewed by others
References
Afridi, H. I., Kazi, T. G., Kazi, N., Kandhro, G. A., Baig, J. A., Shah, A. Q., Jamali, M. K., Arain, M. B., Wadhwa, S. K., & Khan, S. (2011). Chromium and manganese levels in biological samples of Pakistani myocardial infarction patients at different stages as related to controls. Biological Trace Element Research, 142(3), 259–273.
Afridi, H. I., Kazi, T. G., Kazi, N., Talpur, F. N., Arain, S., Brahman, K., Wadhwa, S., & Shah, F. (2013). Distribution of copper, iron, and zinc in biological samples of Pakistani hypertensive patients and referent subjects of different age groups. Clinical Laboratory, 59(9-10), 959–967.
Akın, F., Köse, N., Ayça, B., Katkat, F., & Arınç, H. (2013). Relation between red cell distribution width and severity of coronary artery disease in patients with acute myocardial infarction. Journal of the American College of Cardiology, 62(18), C203.
AL-Rasheed, N. M., Attia, H. A., Mohamed, R. A., Al-Rasheed, N. M., & Al-Amin, M. A. (2014). Preventive effects of selenium yeast, chromium picolinate, zinc sulfate and their combination on oxidative stress, inflammation, impaired angiogenesis and atherogenesis in myocardial infarction in rats. Journal of Pharmacy & Pharmaceutical Sciences, 16(5), 848–867.
Aydın, M., Selcoki, Y., Nazlı, Y., Çolak, N., Yalçın, K. S., Canbal, M., Demirçelik, B., Yiğitoğlu, R., & Eryonucu, B. (2012). Relationship between total antioxidant capacity and the severity of coronary artery. Journal of Clinical and Experimental Investigations, 3. www.jceionline.org.
Azab, B., Torbey, E., Hatoum, H., Singh, J., Khoueiry, G., Bachir, R., McGinn Jr., J. T., McCord, D., & Lafferty, J. (2011). Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction. Cardiology, 119(2), 72–80.
Bagatini, M. D., Martins, C. C., Battisti, V., Gasparetto, D., Da Rosa, C. S., Spanevello, R. M., Ahmed, M., Schmatz, R., Schetinger, M. R. C., & Morsch, V. M. (2011). Oxidative stress versus antioxidant defenses in patients with acute myocardial infarction. Heart and Vessels, 26(1), 55–63.
Bax, J. J., Baumgartner, H., Ceconi, C., Dean, V., Fagard, R., Funck-Brentano, C., Hasdai, D., Hoes, A., Kirchhof, P., & Knuuti, J. (2012). Third universal definition of myocardial infarction. Journal of the American College of Cardiology, 60, 1581–1598.
Börekçi, A., Gür, M., Türkoğlu, C., Çaylı, M., Selek, Ş., Kaypaklı, O., Uçar, H., Coşkun, M., Şeker, T., & Koç, M. (2015). Oxidative stress and paraoxonase 1 activity predict contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology, 66(4), 339–345.
Brunori, E. H. F. R., Lopes, C. T., Cavalcante, A. M. R. Z., Santos, V. B., Lopes, J. d. L., & Barros, A. L. B. L. d. (2014). Association of cardiovascular risk factors with the different presentations of acute coronary syndrome. Revista Latino-Americana de Enfermagem, 22(4), 538–546.
Chacko, S., Haseeb, S., Glover, B. M., Wallbridge, D., & Harper, A. (2017). The role of biomarkers in the diagnosis and risk stratification of acute coronary syndrome. Future Science OA, 4, FSO251.
Chapman, A. R., Adamson, P. D., & Mills, N. L. (2016). Assessment and classification of patients with myocardial injury and infarction in clinical practice. Heart, heartjnl-2016-309530.
Chasapis, C. T., Loutsidou, A. C., Spiliopoulou, C. A., & Stefanidou, M. E. (2012). Zinc and human health: an update. Archives of Toxicology, 86(4), 521–534.
Foster, M., & Samman, S. (2011). 17. Zinc and atherosclerosis: clinical observations and potential mechanisms. Zinc in Human Health, 76, 347.
Gil, G. P., Dessotte, C. A. M., Schmidt, A., Rossi, L. A., & Dantas, R. A. S. (2012). Clinical evolution of patients hospitalized due to the first episode of acute coronary syndrome. Revista Latino-Americana de Enfermagem, 20(5), 830–837.
González-Pacheco, H., Amezcua-Guerra, L. M., Vazquez-Rangel, A., Martínez-Sánchez, C., Pérez-Méndez, O., Verdejo, J., & Bojalil, R. (2015). Levels of high-density lipoprotein cholesterol are associated with biomarkers of inflammation in patients with acute coronary syndrome. American Journal of Cardiology, 116(11), 1651–1657.
Gupta, M., & Chari, S. (2006). Proxidant and antioxidant status in patients of type II diabetes mellitus with IHD. Indian Journal of Clinical Biochemistry, 21(2), 118–122.
Gür, M., Türkoğlu, C., Taşkın, A., Uçar, H., Börekçi, A., Şeker, T., Gözükara, M. Y., Kaypaklı, O., Akyol, S., & Selek, Ş. (2014). Paraoxonase-1 activity and oxidative stress in patients with anterior ST elevation myocardial infarction undergoing primary percutaneous coronary intervention with and without no-reflow. Atherosclerosis, 234(2), 415–420.
Hochman, J. S., Buller, C. E., Sleeper, L. A., Boland, J., Dzavik, V., Sanborn, T. A., Godfrey, E., White, H. D., Lim, J., & LeJemtel, T. (2000). Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: a report from the SHOCK Trial Registry. Journal of the American College of Cardiology, 36(3), 1063–1070.
Huang, L., Teng, T., Bian, B., Yao, W., Yu, X., Wang, Z., Xu, Z., & Sun, Y. (2017). Zinc levels in left ventricular hypertrophy. Biological Trace Element Research, 176(1), 48–55.
Huang, L., Teng, T., Zhao, J., Bian, B., Yao, W., Yu, X., Wang, Z., Xu, Z., & Sun, Y. (2018). The relationship between serum zinc levels, cardiac markers and the risk of acute myocardial infarction by zinc quartiles. Heart, Lung and Circulation, 27(1), 66–72.
Jain, V., & Mohan, G. (1991). Serum zinc and copper in myocardial infarction with particular reference to prognosis. Biological Trace Element Research, 31(3), 317–322.
Kilic, A., Yarlioglues, M., Ercan, E. A., Duran, M., Ugurlu, M., Oksuz, F., Ozdemir, S., Kurtul, A., Karadeniz, M., & Murat, S. N. (2015). Association of total serum antioxidant capacity with the Tei index in echocardiography in patients with microvascular angina. Coronary Artery Disease, 26(7), 620–625.
Koracevic, D., Koracevic, G., Djordjevic, V., Andrejevic, S., & Cosic, V. (2001). Method for the measurement of antioxidant activity in human fluids. Journal of Clinical Pathology, 54(5), 356–361.
Krachler, M., & Irgolic, K. (1999). The potential of inductively coupled plasma mass spectrometry (ICP-MS) for the simultaneous determination of trace elements in whole blood, plasma and serum. Journal of Trace Elements in Medicine and Biology, 13(3), 157–169.
Lavall, M. C., Bonfanti, G., Ceolin, R. B., Schott, K. L., Gonçalves, L. T., Moresco, R. N., Brucker, N., Morsch, V. M., Bagatini, M. D., & Schetinger, M. (2016). Oxidative profile of patients with ST segment elevation myocardial infarction. Clinical Laboratory, 62(5), 971–973.
Lee, S. R., Noh, S. J., Pronto, J. R., Jeong, Y. J., Kim, H. K., Song, I. S., Xu, Z., Kwon, H. Y., Kang, S. C., & Sohn, E.-H. (2015). The critical roles of zinc: beyond impact on myocardial signaling. The Korean Journal of Physiology & Pharmacology, 19(5), 389–399.
Li, F., Gao, J., & Zhang, B. (2016). Association between deficient selenium levels and myocardial infarction: a meta-analysis. International Journal of Clinical and Experimental Medicine, 9, 6086–6092.
Madole, M. B., Bachewar, N. P., & Aiyar, C. M. (2015). Study of oxidants and antioxidants in patients of acute myocardial infarction. Advanced Biomedical Research, 4, 241.
Malavolta, M., Costarelli, L., Giacconi, R., Basso, A., Piacenza, F., Pierpaoli, E., Provinciali, M., Ogo, O. A., & Ford, D. (2017). Changes in Zn homeostasis during long term culture of primary endothelial cells and effects of Zn on endothelial cell senescence. Experimental Gerontology, 99, 35–45.
Martin-Moreno, J., Gorgojo, L., Riemersma, R., Gomez-Aracen, J., Kark, J., Guillen, J., Jimenez, J., Ringstad, J., Fernandez-Crehuet, J., & Bode, P. (2003). Myocardial infarction risk in relation to zinc concentration in toenails. British Journal of Nutrition, 89(05), 673–678.
Members, A. T. F., Steg, P. G., James, S. K., Atar, D., Badano, L. P., Lundqvist, C. B., Borger, M. A., Di Mario, C., Dickstein, K., & Ducrocq, G. (2012). ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European Heart Journal, 33(20), 2569–2619.
More, H., Pujari, K., Jadkar, S., & Patil, C. (2017). Biochemical parameters in acute myocardial infarction with or without co-morbidities. Journal of Medical Science and Clinical Research, 5(02), 17299–17304.
Movahed, A., Iranpour, D., Nabipour, I., Jafari, M., Akbarzadeh, S., Assadi, M., Mirzaei, K., & Hagian, N. (2012). Plasma malondialdehyde, bilirubin, homocysteine and total antioxidant capacity in patients with angiographically defined coronary artery disease. African Journal of Biotechnology, 11, 3187–3191.
Panicker, S., Swathy, S., John, F., & Madambath, I. (2010). Impact of selenium on NFκB translocation in isoproterenol-induced myocardial infarction in rats. Biological Trace Element Research, 138(1-3), 202–211.
Patil, N., Chavan, V., & Karnik, N. (2007). Antioxidant status in patients with acute myocardial infarction. Indian Journal of Clinical Biochemistry, 22(1), 45–51.
Piegas, L. S., Avezum, Á., Pereira, J. C. R., Neto, J. M. R., Hoepfner, C., Farran, J. A., Ramos, R. F., Timerman, A., & Esteves, J. P. (2003). Risk factors for myocardial infarction in Brazil. American Heart Journal, 146(2), 331–338.
Powell, S. R. (2000). The antioxidant properties of zinc. The Journal of Nutrition, 130(5), 1447S–1454S.
Reihani, H., Shamloo, A. S., & Keshmiri, A. (2018). Diagnostic value of D-dimer in acute myocardial infarction among patients with suspected acute coronary syndrome. Cardiology Research, 9(1), 17–21.
Roffi, M., Patrono, C., Collet, J.-P., Mueller, C., Valgimigli, M., Andreotti, F., Bax, J. J., Borger, M. A., Brotons, C., & Chew, D. P. (2016). 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 37(3), 267–315.
Srilakshmi, P., Swetha, D., & Rambabu, K. (2015). Oxidative stress in acute coronary syndrome. Journal of Evolution of Medical and Dental Sciences, 4, 15201–15208.
Steg, G. (2012). Third universal definition of myocardial infarction. European Heart Journal, 33, 2551.
Tardif, J.-C. (2003). Oxidative stress and coronary heart disease. Cardiology Rounds, 7.
Terént, A., & Andersson, B. (1981). The prognosis for patients with cerebrovascular stroke and transient ischemic attacks. Upsala Journal of Medical Sciences, 86(1), 63–74.
Thayer, W. S. (1984). Serum lipid peroxides in rats treated chronically with adriamycin. Biochemical Pharmacology, 33(14), 2259–2263.
Xu, Z., & Zhou, J. (2013). Zinc and myocardial ischemia/reperfusion injury. Biometals, 26(6), 863–878.
Yarlioglues, M., & Kurtul, A. (2017). Association of red cell distribution width with noninfarct-related artery-chronic total occlusion in acute myocardial infarction patients. Biomarkers in Medicine, 11(3), 255–263.
Yu, X., Huang, L., Zhao, J., Wang, Z., Yao, W., Wu, X., Huang, J., & Bian, B. (2018). The relationship between serum zinc level and heart failure: a meta-analysis. BioMed Research International, 2018, 1–9.
Zampaglione, B., Pascale, C., Marchisio, M., & Cavallo-Perin, P. (1996). Hypertensive urgencies and emergencies: prevalence and clinical presentation. Hypertension, 27(1), 144–147.
Zhao, Z., Liu, T., Li, J., Yang, W., Liu, E., & Li, G. (2014). Elevated red cell distribution width level is associated with oxidative stress and inflammation in a canine model of rapid atrial pacing. International Journal of Cardiology, 174(1), 174–176.
Funding
This research was funded by the authors themselves.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The study was approved by the Faculty of Medicine, Assiut University ethical committee in accordance with Helsinki declaration (1975).
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
El-Mahdy, R.I., Mostafa, M.M. & EL-Deen, H.S. Serum Zinc Measurement, Total Antioxidant Capacity, and Lipid Peroxide Among Acute Coronary Syndrome Patients With and Without ST Elevation. Appl Biochem Biotechnol 188, 208–224 (2019). https://doi.org/10.1007/s12010-018-2917-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12010-018-2917-x