Коронарна артериска болест и биолошки маркери на оксидативен стрес

Abstract

Background The coronary artery disease (CAD) is a main reason for morbidity and mortality in the whole world. In the contemporary concept for pathogenesis of the arteriosclerosis, the endothelial injury with an increased production of free radicals that are created in the process of the oxidative stress have more significant role. This study will try to contribute to determining the impact of oxidative stress on the development of CAD, and the connection between risk factors for CAD with changes in oxidative stress. Numerous findings from the literature suggest that oxidative stress is increased in CAD and effective treatment has has still not been found. Aim The study was designed to determine: 1. The relationship of the biological markers of oxidative stress in different groups of CAD; 2. The impact of risk factors (smoking, diabetes, arterial hypertension, hyperlipidemia) of CAD and their relation to changes in oxidative stress. Material and methods The study is a clinical prospective (sectional) study that included 300 patients with coronary artery disease (CAD) and 30 healthy blood donors as a control group. Based on non-invasive methods (electrocardiogram, echocardiography) and laboratory analysis (necrosis markers: myoglobin, troponin, creatine kinase - CK-MB) patients were divided into two groups, with appropriate subgroups. All patients were examined and risk factors for CAD. All patients were assessed for the following biomarkers of oxidative stress: erythrocyte concentration of products of lipid peroxidation reactive with thiobarbiturate acid (Thiobarbituric acid reactive supstances, TBARS), expressed as the concentration of malondialdehyde (MDA), and total hydroperoxides in plasma and red cell activity primary antioxidant enzymes: superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX). Results Patients had an average age of 62,97 ± 11,18 years and those dominated by male (194 or 64.67% men and 106 women, or 35.33%). Of these, 187 (62.3%) patients were diagnosed with acute coronary artery disease, and 113 (37.7%) patients with chronic (ischemia), coronary heart disease. In terms of risk factors for atherogenesis, the arterial hypertension (62.33%) was the most prevalent in patients and then hyperlipidaemia (42.67%), then smoking cigarettes (34.0%) and diabetes (28.33) . In patients with CAD, mainly in patients with acute coronary artery disease have shown an increased level of oxidative damage by elevated concentrations of total hydroperoxides and malondialdehyde and simultaneously reduced antioxidant protection through reduced activity of superoxide dismutase, catalase and glutathione peroxidase. In active smokers with CAD compared to the group of non-smoking patients with CAD and a control group of healthy blood donors was also demonstrated increased oxidative stress. The number of cigarettes smoked significantly affect change in favor of biomarkers of oxidative damage. Also, patients with CAD and diabetes, and in patients with CAD and arterial hypertension had a higher concentration of oxidant, and decreased activity of antioxidant enzymes. Conclusion As a number of studies, this study confirmed that oxidative stress by an imbalance between oxidant and antioxidant status is present in patients with CAD, especially in the acute phase of the disease. Require additional and immediate investigations subgroup with CAD in order to determine an effective treatment for keeping the balance between oxidants concentration and activity of antioxidant enzymes.