Decreased Serum Total Antioxidant Status and Erythrocyte-Reduced Glutathione Levels Are Associated with Increased Serum Malondialdehyde in Atherosclerotic Patients - ScienceDirect

Archives of Medical Research

Volume 33, Issue 3, May–June 2002, Pages 257-260

Archives of Medical Research

https://doi.org/10.1016/S0188-4409(01)00381-2 Get rights and content

Abstract

Background

Coronary artery disease is the significant cause of morbidity and mortality today. The treatment of coronary artery disease is improving, but its prevalence is increasing. Both primary and secondary prevention measures are of vital importance.

Methods

In this study, vitamin C, total antioxidant status, malondialdehyde in serum and erythrocyte-reduced glutathione levels were investigated in patients with atherosclerosis and compared with those of controls. Levels of serum MDA, vitamin C, total antioxidant status, and erythrocyte-reduced glutathione were determined according to the methods of Yagi, Bauer et al., Miller et al., and Beutler, respectively.

Results

Erythrocyte-reduced glutathione, serum vitamin C, total antioxidant status, and malondialdehyde values of both patients with atherosclerosis and controls were as follows: 2.80 ± 0.76, 5.82 ± 0.67 μmol GSH/g Hb; 1.00 ± 0.19, 1.62 ± 0.30 mg/dL; 0.86 ± 0.14, 1.43 ± 0.16 mmol/L, and 4.26 ± 0.9, 1.02 ± 0.80 nmol/mL, respectively. There was a decrease in the levels of serum vitamin C, erythrocyte-reduced glutathione, and total antioxidant status (p <0.001), and increase in the levels of serum malondialdehyde (p <0.001) in patients with atherosclerosis when compared with those of controls.

Conclusions

Because treatment of atherosclerosis is improving, our results suggest that antioxidant agents may have preventive roles in the formation of atherosclerosis.

Introduction

Coronary artery disease (CAD) is the significant cause of morbidity and mortality today. The treatment of CAD is improving, but its prevalence is increasing. Both primary and secondary prevention measures are of vital importance (1).

Atherosclerosis is the principal cause of cardiovascular disease (2). Atherosclerotic lesions are classified as fatty streaks, fibrous plaques, and complex lesions (3). The earliest and most common atherosclerotic lesion is the fatty streak, consisting of subendothelial aggregates of foam cells and mainly of macrophage origin (4).

The oxidation theory of atherosclerosis proposes that the oxidative modification of low density lipoproteins (LDL) plays a central role in the disease (5). Oxidative modification of LDL may be dependent on or independent of lipid peroxidation. This peroxidation may be initiated by metal ions, possibly in association with phospholipase activity, or catalyzed by myeloperoxidase independent of metal ions. These processes are associated with the LDL in the absence of malondialdehyde (MDA)-modified LDL (6). The oxidative hypothesis of atherogenesis is supported by a number of in vitro and in vivo studies demonstrating the proatherogenic properties of oxidized LDL, the occurrence of oxidatively modified LDL in atherosclerotic lesions, and the reduction of atherosclerotic events by antioxidants (7).

The antioxidant content of plasma is critical for LDL protection. In theory, if sufficient lipophilic antioxidants were present then LDL would be protected from even profound oxidant challenge. The balance between the prooxidant challenge and the presence of antioxidants determines the extent of arterial wall modification of LDL (8).

In this study, we investigated vitamin C as an endogenous antioxidant, erythrocyte-reduced glutathione (GSH) as an intracellular antioxidant defense, and total antioxidant status and MDA as an index of lipid peroxidation in serum in patients with atherosclerosis and compared with those of control.

Section snippets

Subjects

Patients with coronary artery disease were included in this study. Briefly, 45 case subjects with vascular disease (30 males and 15 females) and 30 age-grouped control subjects (20 males and 10 females) participated in this study. Patients of the coronary artery disease group were classified according to coronary angiographic evidence of ≥70% stenosis of a major coronary artery. Subjects in the control group were selected clinically healthy individuals. Patients with diabetes were excluded from

Results

The clinical characteristics and lipid profiles of control and patients are presented in Table 1. There were significant increases observed in LDL and triglyceride levels in the patient group when compared to controls. Erythrocyte GSH, serum vitamin C, total antioxidant status, and MDA values of both patients with atherosclerosis and control are found in Table 2. There was a decrease in the levels of vitamin C, total antioxidant status, erythrocyte GSH (p <0.001) and an increase in the levels

Discussion

There has been a growing interest during recent years in the role of free radicals and lipid peroxidation as the cause of cancer and other age-related diseases such as atherosclerosis, rheumatoid arthritis, and cataracts (14). Metabolism of oxygen by cells generates potentially deleterious reactive oxygen species, including superoxide anion radical, hydrogen peroxide, and hydroxyl radical. Under normal physiologic conditions, rate and magnitude of oxidant formation is balanced by rate of

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