Cardiovascular Risk Factors in Normolipidemic Acute Myocardial Infarct Patients on Admission – Do Dietary Fruits and Vegetables Offer Any Benefits?

Kumar, Arun and Sivakanesan, Ramiah (2010) Cardiovascular Risk Factors in Normolipidemic Acute Myocardial Infarct Patients on Admission – Do Dietary Fruits and Vegetables Offer Any Benefits? [Journal (On-line/Unpaginated)]

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Background: Myocardial Infarction (MI) is a leading cause of death in India. Whether dietary vitamins could reduce risk of cardiovascular disease among Indians is still not clear and very few studies have addressed the association between dietary vitamin acting as an antioxidant or pro-oxidant and its effect on risk reduction or aggravation in normolipidemic AMI patients. Objective: The goal of the current study was to address the association between dietary vitamin and cardiovascular risk in normolipidemic acute myocardial infarct patients compared with healthy controls. Design: Dietary intake of vitamins was assessed by 131 food frequency questionnaire items in both AMI patients and age/sex-matched controls. The associated changes in risk factors due to antioxidant vitamins intake was also assessed in normolipidemic acute myocardial patients and was compared with controls. Results: Dietary intake of vitamin A, B1, B2, B3 was significantly higher in AMI patients compared to healthy controls but the intake of vitamin C was significantly higher in controls compared to AMI patients. Even though the vitamins intake was higher in patients, the associated cardiovascular risk factors were not reduced compared to controls. The total cholesterol, LDL-c, TAG were significantly higher (p<0.001) in AMI patients except HDL-c which was significantly higher (p<0.001) in controls. The endogenous antioxidants were found to be significantly lowered in patients compared to controls in spite of higher vitamin intake. Similarly the enzymatic antioxidants were also significantly lowered in patients. The mean serum Lipoprotein (a) malondialdehyde (MDA) and conjugated diene (CD) levels in patients were significantly elevated compared with controls. The levels of caeruloplasmin, C-reactive protein, fibrinogen, ischemia-modified albumin were significantly higher but arylesterase activities were lowered in patients. Conclusion: Diets rich in vegetables and fruits do not seem to reduce the cardiovascular risk in normolipidemic AMI patients among Indians and Sri Lankans.

Item Type:Journal (On-line/Unpaginated)
Keywords:Dietary vitamins; Acute myocardial infarction; Cardiovascular risk factors; Normolipidemia; India; Sri Lanka
Subjects:JOURNALS > Online Journal of Health and Allied Sciences
ID Code:6975
Deposited By: Kakkilaya Bevinje, Dr. Srinivas
Deposited On:22 Nov 2010 14:20
Last Modified:11 Mar 2011 08:57

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Avezum A, Braga J, Santos I, Guimaraes HP, Marin-Neto JA, Piegas LS. Cardiovascular disease in South America: current status and opportunities for prevention. Heart 2009;95:1475-1482 doi:10.1136/hrt.2008.156331.

2. Reddy KS. Cardiovascular disease in India. World Health Stat Q 1993;46:101-107.

3. Chopra V, Wasir H. Implications of lipoprotein abnormalities in Indian patients. Journal Assoc Physicians of India 1998;46:814-818.

4. Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation. 1998;97:596–601.

5. Bulatao RAO, Stephens PW. Demographic estimates and projections, by region, 1970-2015. In: Jamison DT, Mosley WH, eds. Disease control priorities in developing countries. Washington, DC: World Bank, 1990. (Health sector priorities review no. 13.)

6. Ruffin IV MT, Rock CL. Do antioxidants still have a role in the prevention of human cancer? Current Oncology Reports 2001;3:306-313 doi:10.1007/s11912-001-0082-8.

7. Ludwig S, Shen GX. Statins for diabetic cardiovascular complications. Curr Vasc Pharmacol 2006;4:245-251.

8. Kris-Etherton PM, Lichtenstein AH, Howard BV, Steinberg D, Witztum JL. Antioxidant Vitamins Supplements and Cardiovascular Disease. Circulation 2004;110:637-641.

9. Seifried HE, Anderson DE, Sorkin BC, Costello RB. Free Radicals: The Pros and Cons of Antioxidants J. Nutr 2004;134:3143S-3163S.

10. National Cholesterol Education Program. Detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Circulation 2002;106:3143-3421.

11. International Epidemiological Association. Relative validity and reproducibility of a diet history questionnaire in Spain. III. Biochemical markers. EPIC Group of Spain. European Prospective Investigation into Cancer and Nutrition. International Journal of Epidemiology 1997;26:S110-S117.

12. Rose GA, Blackburn H, Gillum RF, Prineas RJ. Cardiovascular Survey Methods. 2nd Ed. WHO Monograph Series No. 56. Geneva. World Health Organisation; 1982.

13. Perry BW, Doumas BT. Effect of heparin on albumin determination by use of bromocresol green and bromocresol purple. Clin Chem 1979;25:1520-1522.

14. Brown H. The determination of uric acid in human blood. Journal of Biological Chemistry. 1945;158:601-608.

15. Jendrassik J, Grof P. Vereinfachte photometrische Methoden Zur Beetimmung des Blutbilirubin. Biochem. Z. 1938;297; 81-89.

16. Paglia DE, Valentine WN. Studies on quantitative and qualitative characterization of erythrocyte glutathione peroxidase. J Lab Clin Med 1967;70:158-169.

17. Sun Y, Oberly LW, Li Y. A simple method for clinical assay of superoxide dismutase. Clin Chem 1988;34:497-500.

18. Beutler E. Red Cell Metabolism: A Manual of Biochemical Methods, 3rd edition. New York, Grune and Stratton, 1984; 105.

19. Beutler E, Duron O, Kelly B. An improved method for the determination of blood glutathione. J Lab Clin Med 1963;61:822-826.

20. Bernheim S, Bernheim MLC, Wilbur KM. The reaction between thiobarbituric acid and the oxidant product of certain lipids. J Biol Chem 1948;174:257-264.

21. Recknagel RO, Glende EA. Spectrophotometric detection of lipid conjugated dienes. Methods Enzymol 1984;105:331-337.

22. Ravin HA. An improved colorimetric enzymatic assay of caeruloplasmin. J Lab Med 1961;58:161-168.

23. Chawla R, Goyal N, Calton R, Goyal S. Ischemia modified albumin: A novel marker for acute coronary syndrome. Indian Journal of Clinical Biochemistry 2006;21(1):77-82.

24. Auxter S. Cardiac Ischemia testing: a new era in chest pain evaluation. Clin Lab News 2003;29:1-3.

25. Roe JH, Kuether CA. The determination of ascorbic acid in whole blood and urine through the 2,4-dinitrophenylhydrazine derivative of dehydroascorbic acid. Journal of Biological Chemistry. 1943;147:399-407.

26. Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation 1998;97:596–601.

27. Chopra V, Wasir H. Implications of lipoprotein abnormalities in Indian patients. The Journal Assoc Physicians of India 1998;46:814-818.

28. Malhotra P, Kumari S, Singh S, Verma S. Isolated Lipid Abnormalities in Rural and Urban Normotensive and Hypertensive North-West Indians. The Journal of Assoc Physicians of India 2003;51:459-463.

29. Vasisht S, Narula J, Awtade A, Tandon R, Srivastava LM. Lipids and lipoproteins in normal controls and clinically documented coronary heart disease patients. Ann Natl Acad Med Sci (India) 1990;26:57-66.

30. Mishra A, Luthra K, Vikram NK. Dyspipidemia in Asian Indians: Determminants and Significance. The Journal of Assoc Physicians of India 2005;52:137-142.

31. Nanda N, Zachariah B, Hamide A. Oxidative Stress and protein glycation in primary hypothyroidism. Male/Female difference. Clinical and Experimental Medicine 2009;8:101-108. doi:10.1007/s10238-008-0164-0

32. Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 341:c4229 doi: 10.1136/bmj.c4229.

33. Riccioni G, Bucciarelli T, Mancini B, Corradi F, Ilio CD, Mattei PA, Orazio ND. Antioxidant Vitamin Supplementation in Cardiovascular Diseases. Annals of Clin Lab Sci 2007; 37:89-95.

34. Morris CD, Carson S. Routine Vitamin Supplementation To Prevent Cardiovascular Disease: A Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003;139:56-70.

35. Honarbakhsh S, Schachter M. Vitamins and cardiovascular disease. Br J Nutr 2009;101(8):1113-1131.

36. Reddy KS, Katan MB. Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutrition 2004;7(1A):167-186

37. Heitman BL, Frederickson P, Lissner L. Hip Circumference and Cardiovascular Morbidity and Mortality in Men and Women. Obesity Research 2004;12:482-487.

38. Megnien JL, Denarie N, Cocaul M. Predicitve value of Waist-to-hip ratio on Cardiovascular Risk Events. Int J Obes Relat Metab Disord 1999;23:90-97.

39. Mishra TK, Routray SN, Patnaik UK, Padhi PK, Satapathy C, Behera M. Lipoprotein (a) and Lipid Profile in Young Patients with Angiographically Proven Coronary Artery Disease. Indian Heart Journal 2001;53:(5) Article No. 60.

40. Das S, Yadav D, Narang R, Das N. Interrelationship between lipid peroxidation, ascorbic acid and superoxide dismutase in coronary artery disease. Current Science 2002;83:488-491.

41. Goswami K Bandyopadhyay. Lipid profile in middle class Bengali population of Kolkata. Indian Journal of Clinical Biochemistry 2003;18:127-130.

42. Kharb S. Low Glutathione levels in acute myocardial infarction. Ind J Med Sci 2003;57(8):335-337.

43. Malhotra P, Kumari S, Singh S, Varma S. Isolated Lipid Abnormalities in Rural and Urban Normotensive and Hypertensive North-West Indians. The Journal of Association of Physicians of India 2003;51:459-463.

44. Burman A, Jain K, Gulati R, Chopra V, Agrawal DP, Vaisisht S. Lipoprotein (a) as a marker of Coronary Artery Disease and its Association with Dietary Fat. The Journal of Assoc Physicians of India 2004;52:99-102.

45. Rajasekhar D, Srinivasa Rao PV, Latheef SA, Saibaba KS, Subramanyam G. Association of serum antioxidants and risk of coronary heart disease in South Indian population. Indian J Med Sci 2004;58(11):465-471.

46. Rani SH, Madhavi G, Ramachandra Rao V, Sahay BK, Jyothy A. Risk factors for coronary heart disease in type II diabetes. Indian J Clin Biochem 2005;20(2):75-80.

47. Sivaraman SK, Zachariah G, Annamalai PT. Evaluation of C - reactive protein and other Inflammatory Markers in Acute Coronary Syndromes. Kuwait Medical Journal 2004;36(1):35-37.

48. Patil N, Chavan V, Karnik N.D. Antioxidant Status in patients with Acute Myocardial Infarction. Indian Journal of Clinical Biochemistry 2007;22:45-51.

49. Shinde S, Kumar P, Patil N. Decreased Levels Of Erythrocyte Glutathione In Patients With Myocardial Infarction. The Internet Journal of Alternative Medicine 2005;2:1.

50. Yadhav AS, Bhagwat VR, Rathod IM. Relationship of Plasma homocysteine with lipid profile parameters in Ischemic Heart disease. Indian Journal of Clinical Biochemistry 2006;21(1):106-110.

51. Olusi SO, Prabha K, Sugathan TN. Biochemical Risk factors for Myocardial Infarction Among South Asian Immigrants and Arabs. Annals of Saudi Medicine 1999;19:147-149.

52. Djousse L, Rothman KJ, Cupples LA, Levy D, Ellison RC. Effect of serum albumin and bilirubin as a risk factor for Myocardial infarction. Am J Cardiol 2003;91:485- 488.

53. Jing F, Alderman MH. Serum uric acid and cardiovascular mortality. JAMA 2000;283:2404-2410.

54. Brand FN, Mcgee DL, Kannel WB, Stokes J, Castelli WP. Hyperuricemia as a risk factor of coronary heart disease: The Framingham Study. American Journal of Epidemiology 1985;121:11-18.

55. Niskanen LK, Laaksonen DE, Nyyssonen K, Alfthan G, Lakka HM, Lakka TA, Salonene JT. Uric acid level as a risk factor for cardiovascular and all- cause moratlity in middle-aged men: a prospective study. Arch Intern Med 2004;164:1546-1551.

56. Nyyssonen K, Markku TP, Salonen R, Tuomilehto J, Salonen JT. Vitamin C deficiency and risk of myocardial infarction: prospective population study of men from eastern Finland. BMJ 1997;314:634.

57. Bhakuni P, Chandra M, Misra MK. Levels of free radical scavengers and antioxidants in post perfused patients of myocardial infarction. Current Science 2005;89:168-170.

58. Bhakuni P, Chandra M, Misra MK. Oxidative stress parameters in erythrocytes of post-reperfused patients with myocardial infarction. J Enzyme Inhib Med Chem 2005;20(4):377-381.

59. Kurl S, Tuomainen TP, Laukkanen JA, Nyyssonen K, Lakka T, Sivenius J, Salonen JT. Plasma Vitamin C Modifies the Association Between Hypertension and Risk of Stroke. Stroke 2002;33:1568.

60. Aulinskas TH, Vander Westhuyzen DR, Coetzee G A. Ascorbate increases the number of low density lipoprotein receptors in cultured arterial smooth muscle cells. Atherosclerosis 1983;47(2):159-171.

61. Senthil S, Veerappan RM, Ramakrishna RM, Pugalendi KV. Oxidative stress and antioxidants in patients with cardiogenic shock complicating acute myocardial infarction. Clin Chim Acta 2004;348(1-2):131-137.

62. Jain A, Gupta HL. Hyperfibrinogenemia in patients of diabetes mellitus in relation to glycemic control and urinary albumin excretion rate. The Journal of Association of Physicians of India 2001;49:227-230.

63. Rajasekhar D, Srinivasa Rao PV, Latheef SA, Saibaba KS, Subramanyam G. Association of serum antioxidants and risk of coronary heart disease in South Indian population. Indian Journal of Medical Sciences 2004;58(11):465-471.

64. Gupta M, Chari S. Proxidant and Antioxidant status in patients of type II Diabetes Mellitus with IHD. Indian Journal of Clinical Biochemistry 2006;21(2):118-122.

65. El- Badry I, Abon El N, Yehia T K, Zakhari MM. Free radicals activity in Acute Myocardial Infarction. The Egyptian Heart Journal 1995;47:71-78.

66. Guha S, Chatterjee S, Mazumder R, Sadek Ali SK, Guha S, Chatterjee N, Biswas S, Bhattacharya GC. Lipoprotein (a), Lipid Tetrad Index and Coronary Artery Disease: A Correlative Study. Indian Heart Journal 2001;53(5), Article No. 28.

67. Bal BS, Bhangu MS, Chhabra N, Sandhu PS, Mahajan M, Batra KS. Incidence of Raised Lipoprotein (a) Level in Cases of Angina with Hyperhomocysteinemia and Normal Lipid Profile. Indian Heart Journal 2001;53:(5) Article No. 47.

68. Nascetti S, D’ Addato S, Pascarelli N, Sangiorgi Z, Grippo MC, Gaddi A. Cardiovascular disease and Lp(a) in the adult population and in the elderly: the Brisighella study. Riv Eur Sci Med Farmacol 1996;18(5-6):205-212.

69. Grobusch KK, Grobbee DE, Koster JF, Lindemans J, Boeing H, Hofman A, Witteman Jacqueline CM. Serum caeruloplasmin as a coronary risk factor in the elderly: the Rotterdam Study. British Journal of Nutrition 1999;81:139-144.

70. Awadallah SM, Hamad M, Jbarah I, Salem NM, Mubarak MS. Autoantibodies against oxidized LDL correlate with serum concentrations of caeruloplasmin in patients with cardiovascular disease. Clin Chim Acta 2006;365:330-336.

71. Giurgea N, Constantinescu MI, Stanciu R, Suciu S, Muresan A. Caeruloplasmin- acute –phase reactant or endogenous antioxidant? The case of cardiovascular disease. Med Sci Monit 2005;11:RA 48-51.

72. Berton G, Cordiano R, Palmieri R, Pianca S, Pagliara V, Palatini P. C-Reactive Protein in Acute Myocardial Infarction: Association With Heart Failure. American Heart Journal 2003;145(6):1094-1101.

73. Bhagat S, Gaiha M, Sharma VK, Anuradha S. A Comparative Evaluation of C - reactive protein as a Short-Term Prognostic Marker in Severe Unstable Angina- A Preliminary Study. The Journal of the Association of Physicians of India 2003;51:349-354.

74. Kulsoom B, Nazrul SH. Association of serum C - reactive protein and LDL: HDL with myocardial infarction. Journal of Pakistan Medical Association 2006;56(7):318-322.

75. Boncler M, Luzak B, Watala C. Role of C-reactive protein in atherogenesis. Postepy Hig Med Dosw 2006;60:538-546.

76. Shukla N, Maher J, Masters J, Angelini G D, Jeremy JY. Does oxidative stress change ceruloplasmin from a protective to a vasculopathic factor? Atherosclerosis 2006;187:238-250.

77. Harkut PV, Sahashrabhojney VS, Salkar RG. Plasma fibrinogen as a marker of major adverse cardiac events in patients of type 2 Diabetes with unstable angina. Int J Diab Dev Countries 2004; 24: 69-74.

78. Coppola G, Rizzo M, Maurizio GA, Corrado E, Alberto DG, Braschi A, Braschi G, Novo S. Fibrinogen as a predictor of mortality after acute myocardial infarction: a forty-two-month follow up study. Ital Heart J 2005;6:315-322.

79. Beg M, Nizami A, Singhal KC, Mohammed J, Gupta A, Azfar SF. Role of serum fibrinogen in patients of ischemic cerebrovascular disease. Nepal Med Coll J 2007;9:88-92.

80. Aviram M, Rosenblat M, Billecke S, Eroul J, Sovenson R, Bisaier CL. Human serum paraoxonase (PON1) is in activated by oxidized low density lipoprotein and preserved by antioxidants. Free Radic Biol Med 1999;26:892-904.

81. Ayub A, Mackness MI, Sharon A, Mackness B, Patel J, Durrington PN. Serum Paraoxonase After Myocardial Infarction. Arteriosclerosis, Thrombosis, and Vascular Biology 1999;19:330-335.

82. Azizi F, Rahmani M, Raiszadeh F, Solati M, Navab M. Associations of lipids, lipoproteins, apolipoproteins and paraoxonase enzyme activity with premature coronary artery disease. Coronary Artery Dis 2002;13(1):9-16.

83. Jarvik GP, Tsai NT, Mckinstry LA, Wani R, Victoria HB, Richter RJ, Schellenberg GD, Heagerty PJ, Hatsukami TS, Furlong CE. Vitamin C and E Intake Is Associated With Increased Paraoxonase Activity. Arteriosclerosis, Thrombosis, and Vascular Biology 2002;22:1329.

84. Sarkar PD, TMS Madhusudhan B. Association between paraoxonase activity and lipid levels in patients with premature coronary artery disease. Clin Chim Acta 2006;373:77-81.

85. Richard JW, Leview I, Righetti A. Smoking Is Associated With Reduced Serum Paraoxonase Activity and Concentration in Patients With Coronary Artery Disease. Circulation 2000;101:2252-2257.

86. Singh S, Venketesh S, Verma JS, Verma M, Lellamma CO, Goel RC. Paraoxonase (PON11) activity in northwest Indian Punjabis with coronary artery disease & type II diabetes mellitus. Indian J Med Res 2007;125:783-787.

87. Pepys MB, Hirschfield G M. C-reactive protein: a critical update. J Clin Invest 2003;111(12):1805-1812. doi: 10.1172/JCI200318921.


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