Carvedilol Enhances the Antioxidant Effect of Vitamins E and C in Chronic Chagas Heart Disease

Abstract

BackgroundChagas disease is still an important endemic disease in Brazil, and the cardiac involvement is its more severe manifestation. ObjectiveTo verify whether the concomitant use of carvedilol will enhance the antioxidant effect of vitamins E and C in reducing the systemic oxidative stress in chronic Chagas heart disease. MethodsA total of 42 patients with Chagas heart disease were studied. They were divided into four groups according to the modified Los Andes classification: 10 patients in group IA (normal electrocardiogram and echocardiogram; no cardiac involvement); 20 patients in group IB (normal electrocardiogram and abnormal echocardiogram; mild cardiac involvement); eight patients in group II (abnormal electrocardiogram and echocardiogram; no heart failure; moderate cardiac involvement); and four patients in group III (abnormal electrocardiogram and echocardiogram with heart failure; severe cardiac involvement). Blood levels of markers of oxidative stress were determined before and after a six-month period of treatment with carvedilol, and six months after combined therapy of carvedilol with vitamins E and C. The markers analyzed were as follows: activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase and reductase, myeloperoxidade and adenosine deaminase; and the levels of reduced glutathione, thiobarbituric-acid reactive substances, protein carbonyls, vitamin E, and nitric oxide. ResultsAfter treatment with carvedilol, all groups showed significant decrease in protein carbonyls and reduced glutathione levels, whereas nitric oxide levels and adenosine activity increased significantly only in the less severely affected group (IA). In addition, the activity of most of the antioxidant enzymes was decreased in the less severely affected groups (IA and IB). By combining the vitamins with carvedilol, a reduction in protein damage, in glutathione levels, and in the activity of most of the antioxidant enzymes were observed. ConclusionsThe decrease in oxidative stress levels observed by means of the markers tested was more significant when carvedilol was used in combination with the antioxidant vitamins. The findings suggest that both carvedilol alone and in combination with the vitamins were effective in attenuating the systemic oxidative stress in patients with Chagas heart disease, especially those less severely affected, thus suggesting the possibility of synergism between these compounds.

Persistence of the benefit of an antioxidant therapy in children and teenagers with Down syndrome

“…In patients with chronic Chagas' disease (Maçao et al, 2007;Ribeiro et al, 2010), as well as in patients with hepatitis C (Farias et al, 2012), a significant improvement in the antioxidant defenses present in the blood of these patients was also found, using the same protocol and experimental design. Moreover, patients with Chagas' disease associated with chronic cardiopathy, after an interval of 6 months without supplementation, also maintained intermediate levels of the same OS markers, not returning to baseline values (Budni, 2011;Budni et al, 2013), in a similar pattern found in the present study.…”

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“…Although, previous research has shown that beta-blockers have antioxidant properties in addition to the beneficial cardiovascular effects. Furthermore, it has been shown that the antioxidant mechanism of these compounds can be through the reduction of oxidative stress (as a ROS and/or RNS scavengers) and decrease in myocardial oxygen demand [32][33][34][35].…”

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“…In addition, ROS leads to a decrease in antioxidant defense such as superoxide dismutase (SOD). Besides being used as a nonselective β -adrenergic blocker, carvedilol has been studied as an antioxidant [6, 7]. It has been demonstrated that inhibition of ROS-induced Smad3 activation by carvedilol could improve myocardial fibrosis [8].…”