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Oxidative Stress and Homocysteine in Coronary Artery Disease

¹ Istituto di Cardiologia, Università degli Studi di Milano, via Parea 4, 20138 Milan, Italy.

² Dipartimento di Chimica Medica e Biochimica, Università degli Studi di Milano, via Saldini 50, 20133 Milan, Italy.

³ Dipartimento di Scienze Mediche, Università degli Studi di Milano, via F. Sforza 35, 20122 Milan, Italy.

⁴ IRCCS–Centro Cardiologico, Fondazione Monzino, via Parea 4, 20138 Milan, Italy.

⁵ Dipartimento di Cardiologia e Cardiochirurgia "G.M. Lancisi", via Baccarani 6, 60100 Ancona, Italy.

^aAuthor for correspondence. Fax 39-02-58011194; e-mail viviana.cavalca{at}unimi.it.

Background: Oxidative stress is present in cardiovascular diseases (CVDs), and hyperhomocysteinemia, an independent risk factor for these diseases, may play a role by inducing production of oxygen free radicals.

Methods: To evaluate the possible role of homocysteine (Hcy) in inducing oxidative stress in coronary artery disease (CAD), plasma Hcy was measured in 68 consecutive cardiovascular patients, and plasma malondialdehyde (MDA), both free and total (free + bound), was measured in 40 patients with CAD (18 with chronic stable angina and 22 with unstable angina). As controls, we tested 70 healthy volunteers. Hcy was measured by an immunoenzymatic method and MDA, an index of lipid peroxidation, by gas chromatography–mass spectrometry.

Results: Plasma Hcy concentrations were significantly higher in cardiovascular patients than in controls (10.2 vs 8.9 µmol/L; P <0.0002), with no significant difference between values in the stable and unstable angina subgroups. Similarly, total MDA was significantly higher in the CAD group than in the controls (2.6 vs 1.3 µmol/L; P <0.00001), again with no significant difference between stable and unstable angina patients. By contrast, free MDA, which was significantly higher in the CAD patients than the controls (0.4 vs 0.2 µmol/L; P <0.00001), was also significantly higher in the unstable than in the stable angina group (0.5 vs 0.3 µmol/L; P <0.03). However, no correlation was observed among Hcy and free and total MDA.

Conclusions: Our findings show that a moderate increase of Hcy is associated with CVD but that Hcy at the detected values cannot be considered completely responsible for oxidative damage. That lipid peroxidation is involved in CAD is shown by our observation of significantly increased plasma free and total MDA concentrations compared with controls. Moreover, free MDA values discriminated between unstable and chronic stable angina, and could thus represent a new diagnostic tool.

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