The kidney is the most sensitive organ to cadmium-induced toxicity, particularly in conditions of long-term ongoing oxidative stress. We hypothesized that, in kidney transplant recipients (KTR), the nephrotoxic exposure to cadmium represents an overlooked hazard for preserved graft functioning.
It currently remains understudied whether low consumption of fruits and vegetables after kidney transplantation may be a modifiable cardiovascular risk factor. We aimed to investigate the associations between consumption of fruits and vegetables and cardiovascular mortality in renal transplant recipients (RTRs).Consumption of fruits and vegetables was assessed in an extensively phenotyping cohort of RTRs. Multivariable-adjusted Cox proportional hazards regression analyses were performed to assess the risk of cardiovascular mortality.We included 400 RTRs (age 52 ± 12 years, 54% males). At a median follow-up of 7.2 years, 23% of RTRs died (53% were due to cardiovascular causes). Overall, fruit consumption was not associated with cardiovascular mortality {hazard ratio [HR] 0.82 [95% confidence interval (CI) 0.60-1.14]; P = 0.24}, whereas vegetable consumption was inversely associated with cardiovascular mortality [HR 0.49 (95% CI 0.34-0.71); P < 0.001]. This association remained independent of adjustment for several potential confounders. The association of fruit consumption with cardiovascular mortality was significantly modified by estimated glomerular filtration rate (eGFR; Pinteraction = 0.01) and proteinuria (Pinteraction = 0.01), with significant inverse associations in patients with eGFR > 45 mL/min/1.73 m2 [HR 0.56 (95% CI 0.35-0.92); P = 0.02] or the absence of proteinuria [HR 0.62 (95% CI 0.41-0.92); P = 0.02].In RTRs, a relatively higher vegetable consumption is independently and strongly associated with lower cardiovascular mortality. A relatively higher fruit consumption is also associated with lower cardiovascular mortality, although particularly in RTRs with eGFR > 45 mL/min/1.73 m2 or an absence of proteinuria. Further studies seem warranted to investigate whether increasing consumption of fruits and vegetables may open opportunities for potential interventional pathways to decrease the burden of cardiovascular mortality in RTRs.
Postoperative atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery with extracorporeal circulation. The pathogenesis of postoperative AF is multifactorial. Oxidative stress, caused by the unavoidable ischemia-reperfusion event occurring in this setting, is a major contributory factor. ROS-derived effects could result in lipid peroxidation, protein carbonylation or DNA oxidation of cardiac tissue, thus leading to functional and structural myocardial remodeling. The vulnerability of myocardial tissue to the oxidative challenge is also dependent on the activity of the antioxidant system. High ROS levels, overwhelming this system, should result in deleterious cellular effects, such as the induction of necrosis, apoptosis or autophagy. Nevertheless, tissue exposure to low to moderate ROS levels could trigger a survival response with a trend to reinforce the antioxidant defense system. Administration of n-3 polyunsaturated fatty acids (PUFA), known to involve a moderate ROS production, is consistent with a diminished vulnerability to the development of postoperative AF. Accordingly, supplementation of n-3 PUFA successfully reduced the incidence of postoperative AF after coronary bypass grafting. This response is due to an up-regulation of antioxidant enzymes, as shown in experimental models. In turn, non-enzymatic antioxidant reinforcement through vitamin C administration prior to cardiac surgery has also reduced the postoperative AF incidence. Therefore, it should be expected that a mixed therapy result in an improvement of the cardioprotective effect by modulating both components of the antioxidant system. We present available evidence supporting the view of an effective prevention of postoperative AF including a 2-step therapeutic strategy: n-3 PUFA followed by vitamin C supplementation to patients scheduled for cardiac surgery with extracorporeal circulation. The present study should encourage the design of clinical trials aimed to offer ne
Background: Acute myocardial infarction (AMI) is the leading cause of morbidity and mortality worldwide.The final infarct size (FIS) and left ventricular ejection fraction (LVEF) are the greatest predictors of post-AMI mortality, with cardiac magnetic resonance (CMR) being the gold standard method for their measurement.Myocardial damage biomarkers, such as creatine kinase (CK) and myocardial creatine kinase (CKMB) are currently used to diagnose AMI and estimate the myocardial damage extent.It would be plausible to use them as predictors of FIS and LVEF; however, current evidence is not available up to date.Objective: To determine the potential power of plasma CK and CKMB levels as predictors of FIS and LVEF impairment, respectively, on the basis of their correlation in patients undergoing primary coronary angioplasty (PCA) following ST-elevation acute myocardial infarction (STEMI). Methodology:A retrospective analysis of PREVEC Trial (ISRCTN registry: 56034553), a multicentric, randomized, double-blind clinical study was performed.Sixty-seven patients with STEMI scheduled for PCA were enrolled.The CMR was performed 7-15 days after the event.Three radiologists blinded to clinical information measured FIS and LVEF.Total CK and CKMB were measured in peripheral venous blood at 6-8 hours after PCA.Correlation coefficient were obtained, and the tests were considered significant with a p value <0.05.The software GraphPrism 6.0 was used for the statistical analysis.Results: A significant positive correlation was obtained between levels of cardiac biomarkers and FIS [total CK (r-square 0.3, p<0.0001) and CK MB (r-square 0.15, p<0.0027)].In addition, the levels of these biomarkers showed a significant negative correlation with LVEF [total CK (r-square 0.3, p<0.0001) and CK MB (r-square 0.18, p<0.0012)]. Conclusion:These results are consistent with the view that the myocardial damage biomarkers CK and CKMB are reliable as predictors of FIS and LVEF measured by CMR in post-AMI patients.These data suggest that these biomarkers could be included in future Risk Scores.