title: Effect of preoperative supplementation with alpha-tocopherol and ascorbic acid on myocardial injury in patients undergoing cardiac operations.
abstract: Augmentation of antioxidant defenses may help protect tissues against ischemia-reperfusion injury associated with operations involving cardiopulmonary bypass. In this study we examined the effect of pretreating patients with alpha-tocopherol (vitamin E) and ascorbic acid (vitamin C) or placebo on injury to the myocardium. Seventy-six subjects undergoing elective coronary artery bypass grafting participated in a prospective, double-blind, placebo-controlled randomized trial, receiving either placebo or both 750 IU dl-alpha-tocopherol per day for 7 to 10 days and 1 gm ascorbic acid 12 hours before the operation. Plasma alpha-tocopherol concentrations, raised fourfold by supplementation, fell by 70% after the operation in the supplemented group and to negligible levels in the placebo group. There were no significant differences between the groups with respect to release of creatine kinase MB isoenzyme over 72 hours, nor in the reduction of the myocardial perfusion defect determined by thallium 201 uptake. Electrocardiography provided no evidence of a benefit from antioxidant supplementation. Thus the supplementation regimen prevented the depletion of the primary lipid soluble antioxidant in plasma, but provided no measurable reduction in myocardial injury after the operation.
authors.affiliation: Department of Cardiology, Royal Brisbane Hospital, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Westhuyzen
authors.forename: A D
authors.initials: AD
authors.lastname: Cochrane
authors.forename: P J
authors.initials: PJ
authors.lastname: Tesar
authors.forename: T
authors.initials: T
authors.lastname: Mau
authors.forename: D B
authors.initials: DB
authors.lastname: Cross
authors.forename: M P
authors.initials: MP
authors.lastname: Frenneaux
authors.forename: F A
authors.initials: FA
authors.lastname: Khafagi
authors.forename: S J
authors.initials: SJ
authors.lastname: Fleming
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001205:Ascorbic Acid / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000187:drug effects*; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D011292:Premedication; D011300:Preoperative Care; D011446:Prospective Studies; D013794:Thallium Radioisotopes; D014810:Vitamin E / Q000097:blood / Q000494:pharmacology*
chemical_list: D007527:Isoenzymes; D013794:Thallium Radioisotopes; D014810:Vitamin E; D003402:Creatine Kinase; D001205:Ascorbic Acid