Oxidative Stress and Antioxidant Status in Patients of acute Myocardial Infarction before and after Regular Treatment

Q: What are the key findings of this study?

Regular AMI treatment for 5 days reduced plasma MDA from 4.76 to 2.78 µmol/L and increased erythrocyte GSH and plasma vitamin E levels.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (AMI) (n=90). Intervention: Regular conventional AMI treatment (streptokinase, morphine, prochlorperazine, clopidogrel, atorvastatin) vs. Baseline (pre-treatment) and healthy control subjects. Primary outcome: Plasma malondialdehyde (MDA) level (µmol/L) at day 5 of treatment vs. baseline (p=<0.001).

Q: What does this research mean for the field?

Standard medical treatment for acute myocardial infarction significantly reduces plasma MDA and restores antioxidant defense by increasing erythrocyte GSH and plasma vitamin E levels within five days. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate oxidative stress and antioxidant levels in acute myocardial infarction patients before and after conventional treatment, and assess associations with diabetes mellitus and dyslipidemia.

Tahmina Bashar; Nargis Akhter

doi:10.3329/uhj.v10i2.26122

December 28, 2015University Heart JournalOpen Access

Oxidative Stress and Antioxidant Status in Patients of acute Myocardial Infarction before and after Regular Treatment

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Key result

Standard AMI medical therapy cuts plasma MDA ~42% at five days while boosting antioxidant levels.

P<0.001
n=90

Why the study?

Does regular conventional AMI treatment ameliorate oxidative stress (plasma MDA) and restore antioxidant status (erythrocyte GSH and plasma vitamin E) in patients with acute myocardial infarction over 5 days?

Key Points

To evaluate oxidative stress and antioxidant levels in acute myocardial infarction patients before and after conventional treatment, and assess associations with diabetes mellitus and dyslipidemia.
Prospective observational study conducted in Dhaka, Bangladesh, evaluating 72 acute myocardial infarction patients (mean age 53.15 ± 7.59 years) and 18 healthy controls (mean age 54.13 ± 6.74 years).
Patients were categorized into four subgroups of 18 each based on the presence of diabetes mellitus, dyslipidemia, both conditions, or neither.
Blood samples were collected on admission prior to treatment and on the 5th day of conventional therapy (streptokinase, morphine, prochlorperazine, clopidogrel, atorvastatin) to measure plasma malondialdehyde, erythrocyte reduced glutathione, and plasma vitamin E.
At admission, acute myocardial infarction patients exhibited significantly increased plasma malondialdehyde levels (p<0.001) alongside significantly decreased erythrocyte reduced glutathione and plasma vitamin E levels (p<0.001) compared with controls.
By the 5th day of regular treatment, plasma malondialdehyde levels significantly decreased (p<0.001), while erythrocyte reduced glutathione and plasma vitamin E concentrations significantly increased (p<0.001).
Patients with both dyslipidemia and diabetes mellitus experienced significantly greater increases in malondialdehyde and steeper reductions in vitamin E levels compared to patients without either risk factor (p<0.001).

Study Design

Type

Cohort (n=90)

Multicenter

Yes

Structured PICO

Does regular conventional AMI treatment ameliorate oxidative stress (plasma MDA) and restore antioxidant status (erythrocyte GSH and plasma vitamin E) in patients with acute myocardial infarction over 5 days?

P

Population

90 participants in Bangladesh (72 AMI patients with mean age 53.15 years and 18 healthy controls with mean age 54.13 years, 29% female), followed for 5 days of conventional AMI therapy.

E

Exposure

Regular conventional therapy for AMI including injectable streptokinase, injectable morphine, injectable prochlorperazine, oral clopidogrel, and oral atorvastatin (plus continuation of antihypertensive, antidiabetic, and lipid-lowering agents as needed) for 5 days

C

Comparator

Pre-treatment baseline in AMI patients (n=72) and healthy normotensive, non-diabetic controls (n=18)

O

Outcome

Plasma malondialdehyde (MDA, measured as TBARS), erythrocyte reduced glutathione (GSH), and plasma vitamin E levels on the 5th day of regular treatment compared to baseline and healthy controlssurrogate

Main Result

Absolute Event Rate: 2.78% vs 4.76%

p-value: p=<0.001

Patients with acute myocardial infarction exhibit heightened oxidative stress and depleted endogenous antioxidants (particularly when comorbid diabetes and dyslipidemia are present), which partially normalize after 5 days of standard medical and fibrinolytic therapy.

Limitations

Small sample size due to unavailability of resources such as manpower, financial support, and time limitation
Small sample size due to unavailability of manpower, financial support, and time limitation

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Implication

Standard AMI therapy was associated with reduced oxidative stress over 5 days; leaves open whether this is causal or warrants targeted trials.

Abstract

In acute myocardial infarction (AMI), generation of free radicals contribute to its pathogenesis. We evaluated the extent of oxidative stress and its amelioration in AMI patients after regular treatment and assessed its association with risk factors like dyslipidemia and diabetes mellitus (DM). Plasma MDA level increased (p<0.001) and erythrocyte GSH and plasma vitamin E levels decreased (p<0.001) in AMI patients. On the 5th day of regular treatment MDA level reduced (p<0.001) and erythrocyte GSH and vitamin E levels increased (p<0.001). The rise in MDA and fall in vitamin E levels were significant (p<0.001) in patients with both dyslipidemia and DM in comparison to patients without dyslipidemia or DM. It is concluded that an imbalance exists between oxidant and antioxidant molecules in AMI patients which shifts towards oxidative side and treatment restores this balance. There may be some association between oxidative stress in AMI and risk factors like dyslipidemia and diabetes mellitus.University Heart Journal Vol. 10, No. 2, July 2014; 60-65

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Cite This Study

Bashar et al. (2015) conducted a cohort in Acute myocardial infarction (AMI) (n=90). Regular conventional AMI treatment (streptokinase, morphine, prochlorperazine, clopidogrel, atorvastatin) vs. Baseline (pre-treatment) and healthy control subjects was evaluated on Plasma malondialdehyde (MDA) level (µmol/L) at day 5 of treatment vs. baseline (p=<0.001). Regular AMI treatment for 5 days reduced plasma MDA from 4.76 to 2.78 µmol/L and increased erythrocyte GSH and plasma vitamin E levels.

synapsesocial.com/papers/6a91768aeb80182e011212a5 https://doi.org/10.3329/uhj.v10i2.26122

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Oxidative Stress and Antioxidant Status in Patients of acute Myocardial Infarction before and after Regular Treatment

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Oxidative Stress and Antioxidant Status in Patients of acute Myocardial Infarction before and after Regular Treatment

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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