INCREASED OXIDATIVE STRESS IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

Objectives. We sought to study the markers of lipid peroxidation and d efenses against oxidative stress in patients with varying degrees of h eart failure. Background. Despite advances in other areas of cardiovas cular disease, the morbidity and mortality from congestive heart failu re (CHF) are increasing, Data mainly from animal models suggest that f ree radical injury may promote myocardial decompensation. However, the re are no studies in humans correlating the severity of heart failure with increased free radical injury and antioxidants. Methods. Fifty-ei ght patients with CHF and 19 control subjects were studied. In additio n to complete clinical and echocardiographic evaluations, the prognosi s of these patients was established by measuring the levels of soluble tumor necrosis factor-alpha receptors 1 and 2 (sTNF-R1 and sTNF-R2). Oxidative stress was evaluated by measuring plasma lipid peroxides (LP O), malondialdehyde (MDA), glutathione peroxidase (GSHPx) and vitamin E and C levels. Results. The patients' age range, cause of heart failu re and drug intake were comparable across the different classes of hea rt failure. Heart failure resulted in a significant increase in LPO (p < 0.005), MDA (p < 0.005), sTNF-R1 (p < 0.005) and sTNF-R2 (p < 0.005 ). There was a significant positive correlation between the clinical c lass of heart failure and LPO, MDA, sTNF-R1 and sTNF-R2 levels, There was an inverse correlation between GSHPx and LPO, With increased lipid peroxidation in patients with CHF, the levels of vitamin C decreased, but vitamin E levels were maintained. Conclusions. These data demonst rate a progressive increase in free radical injury and encroachment on antioxidant reserves with the evolution of heart failure; they also s uggest that oxidative stress may be an important determinant of progno sis, The therapeutic benefit of administering antioxidant supplements to patients with CHP should be evaluated. (C) 1998 by the American Col lege of Cardiology.