title: Carvedilol enhances the antioxidant effect of vitamins E and C in chronic Chagas heart disease.
abstract: BACKGROUND
  Chagas disease is still an important endemic disease in Brazil, and the cardiac involvement is its more severe manifestation.
  
  
  OBJECTIVE
  To verify whether the concomitant use of carvedilol will enhance the antioxidant effect of vitamins E and C in reducing the systemic oxidative stress in chronic Chagas heart disease.
  
  
  METHODS
  A total of 42 patients with Chagas heart disease were studied. They were divided into four groups according to the modified Los Andes classification: 10 patients in group IA (normal electrocardiogram and echocardiogram; no cardiac involvement); 20 patients in group IB (normal electrocardiogram and abnormal echocardiogram; mild cardiac involvement); eight patients in group II (abnormal electrocardiogram and echocardiogram; no heart failure; moderate cardiac involvement); and four patients in group III (abnormal electrocardiogram and echocardiogram with heart failure; severe cardiac involvement). Blood levels of markers of oxidative stress were determined before and after a six-month period of treatment with carvedilol, and six months after combined therapy of carvedilol with vitamins E and C. The markers analyzed were as follows: activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase and reductase, myeloperoxidade and adenosine deaminase; and the levels of reduced glutathione, thiobarbituric-acid reactive substances, protein carbonyls, vitamin E, and nitric oxide.
  
  
  RESULTS
  After treatment with carvedilol, all groups showed significant decrease in protein carbonyls and reduced glutathione levels, whereas nitric oxide levels and adenosine activity increased significantly only in the less severely affected group (IA). In addition, the activity of most of the antioxidant enzymes was decreased in the less severely affected groups (IA and IB). By combining the vitamins with carvedilol, a reduction in protein damage, in glutathione levels, and in the activity of most of the antioxidant enzymes were observed.
  
  
  CONCLUSIONS
  The decrease in oxidative stress levels observed by means of the markers tested was more significant when carvedilol was used in combination with the antioxidant vitamins. The findings suggest that both carvedilol alone and in combination with the vitamins were effective in attenuating the systemic oxidative stress in patients with Chagas heart disease, especially those less severely affected, thus suggesting the possibility of synergism between these compounds.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Budni
authors.forename: Roberto Coury
authors.initials: RC
authors.lastname: Pedrosa
authors.forename: Eduardo Monguilhott
authors.initials: EM
authors.lastname: Dalmarco
authors.forename: Juliana Bastos
authors.initials: JB
authors.lastname: Dalmarco
authors.forename: Tânia Sílvia
authors.initials: TS
authors.lastname: Frode
authors.forename: Danilo
authors.initials: D
authors.lastname: Wilhelm Filho
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000975:Antioxidants / Q000032:analysis; D001205:Ascorbic Acid / Q000494:pharmacology* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002227:Carbazoles / Q000494:pharmacology* / Q000627:therapeutic use; D000077261:Carvedilol; D014355:Chagas Disease / Q000188:drug therapy* / Q000378:metabolism; D002908:Chronic Disease; D004357:Drug Synergism; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects*; D011412:Propanolamines / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014810:Vitamin E / Q000494:pharmacology* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D000975:Antioxidants; D015415:Biomarkers; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D014810:Vitamin E; D001205:Ascorbic Acid