Effect of Antioxidant-Rich Foods on Plasma Ascorbic Acid, Cardiac Enzyme, and Lipid Peroxide Levels in Patients Hospitalized with Acute Myocardial Infarction

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Abstract

Objective To determine whether a fat- and energy-reduced diet rich in antioxidant vitamins C and E, beta carotene, and soluble dietary fiber reduces free-radical stress and cardiac enzyme level and increases plasma ascorbic acid level 1 week after acute myocardial infarction.

Design Randomized, single blind, controlled study.

Setting Primary- and secondary-care research center for patients with myocardial infarction.

Subjects All subjects with suspected acute myocardial infarction (n=505) were considered for entry to the study. Subjects with definite or possible acute myocardial infarction and unstable angina (according to World Health Organization criteria) were assigned to either an intervention diet (n=204) or a control diet (n=202) within 48 hours of symptoms of infarction.

Interventions Intervention and control groups were advised to consume a fat-reduced, oil-substituted diet. The intervention group was also advised to eat more fruits, vegetable soup, pulses, and crushed almonds and walnuts mixed with skim milk.

Main outcome measures Reduction in plasma lipid peroxide and lactate dehydrogenase cardiac enzyme levels, increase in plasma ascorbic acid level, and compliance with diet, especially with vitamin C intake as determined by chemical analysis.

Statistical analysis A two-sample t test using one-way analysis of variance for comparison of data.

Results Plasma lipid peroxide level decreased significantly in the intervention group compared with the control group (0.59 pmol/L in the intervention group and 0.10 pmol/L in the control group; 95% confidence interval of difference=0.19 to 0.83). Lactate dehydrogenase level increased less in the intervention group than in the control group (427.7 vs 561.2 U/L; confidence interval of difference=82.9 to 184.7). Plasma ascorbic acid level increased more in the intervention group than in the control group (23.38 vs 7.95 (μmol/L; confidence interval of difference −12.85 to 26.13)

Applications/conclusions Consumption of an antioxidant-rich diet may reduce the plasma levels of lipid peroxide and cardiac enzyme and increase the plasma level of ascorbic acid. Antioxidant-rich foods may reduce myocardial necrosis and reperfusion injury induced by oxygen free radicals. J Am Diet Assoc. 1995; 95:775-780.

Section snippets

Subjects and Methods

Between July 1987 and June 1990, all patients admitted to the Medical Hospital and Research Center (Moradabad, India) within 24 hours of onset of suspected acute myocardial infarction were considered for this study. Details about patients and methods have been described elsewhere (12), (13). The diagnosis of acute myocardial infarction was made using a 12-lead electrocardiogram; the criteria (14) were symmetrical ST segment elevation 1 mm or more from baseline in limb leads, elevation of more

Results

(Table 1) shows that the percentages for number of men, subjects with hypertension, and other known risk factors were comparable for the two groups (12), (13). Smoking and alcohol intake were not different for the intervention and control groups (Table 1). Electrocardiographic sites of acute myocar-dial infarction and initial levels of cardiac enzymes were similar in both groups. The diagnoses of acute myocardial infarction, possible acute myocardial infarction, and unstable angina were also

Discussion

This study showed that increased consumption of antioxidant vitamin C increased the availability of plasma vitamin C by 75.5%, which may have resulted in the reduced lipid peroxide level (−16.5%) and a smaller increase inlactate dehydrogenase cardiac enzyme (65.0%) from initial levels. In contrast, changes were minor in the control group. Within the intervention group, subjects who consumed greater amounts of foods rich in ascorbic acid showed greater benefit at these levels: A rise in cardiac

Applications

The evidence of association between plasma ascorbate and acute myocardial infarction from this randomized, controlled intervention trial is sufficiently strong to suggest that foods rich in ascorbic acid, and possibly foods rich in other antioxidants such as vitamin E and beta carotene, should be provided to patients with acute myocardial infarction to quench free radical overproduction and prevent myocardial necrosis, complications, and mortality (12), (13), (31), (32), (33). Simultaneous

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