Effects of Therapeutic Lifestyle Change Diet and Q10 Plus L-Carnitine Supplementation on Inflammatory Biomarkers of In-Stent Restenosis, Lipid Profile, and Left Ventricular Ejection Fraction in Myocardial Infarction: A Randomized Clinical Trial

Background: Following Myocardial Infarction (MI) and percutaneous coronary intervention (PCI), the modification of cardiovascular risk factors and inflammation can improve MI progression and PCI outcomes. Up to now, no certain conclusions have been drawn regarding the effect of therapeutic lifestyle change (TLC) diet and a combination of Q10 plus L-carnitine (LC) supplementation on inflammatory biomarkers of In-Stent Restenosis (ISR), lipid profile, and Left ventricular ejection fraction (LVEF). Objectives: This study aimed to evaluate the effects of TLC diet and Q10 plus LC supplementation on inflammatory biomarkers of ISR, lipid profile, and LVEF following MI and PCI. Methods: This single-blind randomized controlled trial was conducted on 128 subjects. After randomization for treatment allocation, the subjects were divided into the study groups through block randomization. The MI patients were admitted to 2 hospitals, namely Al-Zahra and Kowsar (Shiraz, Iran), between April 2015 and May 2016. The patients were divided into 4 groups receiving TLC diet (A), oral Q10 150 mg/d and LC 1200 mg/d (B), a combination of LC plus Q10 and TLC diet (C), and the routine care (D). This study evaluated Interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) as inflammatory biomarkers of ISR, lipid profile, and LVEF in 128 patients with MI undergoing PCI before and 3 months after the intervention. Results: The results showed a significant decrease in hs-CRP in groups B (11.8 ± 4.3 to 2.0 ± 1 mg/L) and C (11.7±3.9 to 1.3±1.1 mg/L) (P < 0.0001 and P < 0.0001, respectively), but not in group A. Also, a significant reduction was found in IL-6 in groups A (38.0 ± 15 to 9.4 ± 2 pg/mL), B (34.6 ± 12 to 5.1 ± 2.4 pg/mL), and C (33.7 ± 12 to 4.8 ± 2.1 pg/mL) (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). Additionally, LDL and total cholesterol, but not TG, levels significantly decreased in groups A (150 ± 17 to 80 ± 13 mg/dL), B (148 ± 15 to 77.2 ± 14 mg/dL), and C (142 ± 11 to 64.8 ± 10 mg/dL) (P < 0.0001, P < 0.001, and P < 0.0001, respectively). Nevertheless, only group C showed a significant improvement in LVEF (45.1 ± 8 to 53.6 ± 8) (P < 0.027). Conclusions: An adjuvant therapy with TLC diet and supplementation with Q10 and LC seems to be required for secondary prevention following MI and PCI. TLC diet and Q10 plus LC appeared to be effective in inflammatory biomarkers of ISR as well as LDL reduction.