Antioxidant Therapeutic Strategies for Cardiovascular Conditions Associated with Oxidative Stress
Abstract
:1. Introduction
2. Oxidative Stress in Cardiovascular Disease
Sources of ROS in Cardiovascular Pathologies
3. Cardiac Diseases Related to Myocardial Hypoxia/Ischemia
3.1. Therapeutic Strategies Related with Hypoxia/Ischemia
3.1.1. Cardiac Ischemic Preconditioning
3.1.2. Pharmacological Preconditioning
3.2. Novel Antioxidant-Based Therapies in Ischemia–Reperfusion
3.2.1. Cardiac Preconditioning with Omega 3
3.2.2. Antioxidant Mechanism Induced by Omega 3
3.2.3. Microribonucleic Acids (miRNAs)
miRNA as a Therapeutic Strategy
4. Oxidative Stress and Cardiotoxicity
4.1. Chemotherapy-Induced Cardiotoxicity Secondary to the Collateral Damage of Oxidative Stress on Non-Target Tissues
4.2. Mechanisms of Anthracycline-Induced Cardiotoxicity
4.3. Preventive Therapies for Anthracycline-Induced Cardiotoxicity with Direct or Indirect Antioxidant Effects
4.3.1. Reactive Oxygen Species Scavengers
4.3.2. Prevention of Reactive Oxygen Species Generation
Carvedilol
Omega-3
4.4. Chemotherapy-Induced Cardiotoxicity of Other Non-Anthracycline Agents
5. Antioxidant-Based Strategies in Congenital Heart Disease Surgical Correction
5.1. Glucocorticoids
5.2. Antioxidants
5.3. Controlling Oxygen Supply
5.4. Propofol Anesthesia
6. Novel Experimental Antioxidant-Based Therapies
7. Concluding Remarks
Acknowledgments
Conflicts of interest
References
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Trial (N) | Primary End Point | Treatment/Results (R) | Reference |
---|---|---|---|
Kalay et al., 2006 (n = 50) | Reduction in LVEF between baseline and 6 months | Treatment: Carvedilol 12.5 mg daily vs. placebo. The interventions were initiated prior to the start of chemotherapy and maintained for 6 months. Results: Placebo: LVEF 68.9%→52.3%, statistically significant reduction (p < 0.001); Carvedilol: LVEF 70.5%→69.7%, no statistically significant reduction (p = 0.3) | [129] |
OVERCOME Trial (n = 90) | The primary efficacy endpoint was the absolute change in LVEF between baseline and 6 months | Treatment: Enalapril + carvedilol vs. no treatment Medications titrated as tolerated. Medications started within 1 week before the first chemotherapy cycle and continued for 6 months. Results: Control: LVEF 64.6%→57.9%, statistically significant reduction, resulting in a −3.1% absolute difference by echocardiography and −3.4% by cardiac magnetic resonance. Enalapril + carvedilol: LVEF 63.3%→62.9%, no statistically significant changes. | [130] |
POAF, Chilean Trial (n = 203) | Relative risk of reduction the occurrence of electrocardiographically confirmed POAF from surgery until hospital discharge. Follow-up 14 days. | Patients were randomized to placebo or supplementation with n-3 polyunsaturated fatty acids (2 g/day) (EPA: DHA ratio 1:2), vitamin C (1 g/day), and vitamin E (400 IU/day). Results: Supplemented group versus placebo group (relative risk (RR): 0.28) (p < 0.01). | [144] |
OPERA Trial (n = 564) | Incident POAF lasting ≥30 s, centrally adjudicated, and confirmed by rhythm strip or electrocardiography | Fish oil or placebo supplementation (10 g over 3 to 5 days, or 8 g over 2 days). R: neither higher habitual circulating omega 3 levels, nor achieved levels or changes following short-term fish oil supplementation are associated with risk of POAF. | [145] |
The OMEGA-Study in Critical Ill Patients (n = 272) | Patients with acute lung injury would increase ventilator-free days to study day 28. | Twice-daily enteral supplementation of n-3 fatty acids, γ-linolenic acid, and antioxidants compared with an isocaloric control. R: patients receiving the omega 3 supplement had fewer ventilator-free days (14.0 vs. 17.2; p = 0.02) (difference, −3.2 (95% CI, −5.8 to −0.7)) and intensive care unit-free days (14.0 vs. 16.7; p = 0.04). The study was stopped | [146] |
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Farías, J.G.; Molina, V.M.; Carrasco, R.A.; Zepeda, A.B.; Figueroa, E.; Letelier, P.; Castillo, R.L. Antioxidant Therapeutic Strategies for Cardiovascular Conditions Associated with Oxidative Stress. Nutrients 2017, 9, 966. https://doi.org/10.3390/nu9090966
Farías JG, Molina VM, Carrasco RA, Zepeda AB, Figueroa E, Letelier P, Castillo RL. Antioxidant Therapeutic Strategies for Cardiovascular Conditions Associated with Oxidative Stress. Nutrients. 2017; 9(9):966. https://doi.org/10.3390/nu9090966
Chicago/Turabian StyleFarías, Jorge G., Víctor M. Molina, Rodrigo A. Carrasco, Andrea B. Zepeda, Elías Figueroa, Pablo Letelier, and Rodrigo L. Castillo. 2017. "Antioxidant Therapeutic Strategies for Cardiovascular Conditions Associated with Oxidative Stress" Nutrients 9, no. 9: 966. https://doi.org/10.3390/nu9090966