Preventing Myocardial Injury Following Non-Cardiac Surgery: A Potential Role for Preoperative Antioxidant Therapy with Ubiquinone

Abstract

Over 240 million non-cardiac operations occur each year and are associated with a 15–20% incidence of adverse perioperative cardiovascular events. Unfortunately, preoperative therapies that have been useful for chronic ischemic heart diseases, such as coronary artery revascularization, antiplatelet agents, and beta-blockers have failed to improve outcomes. In a pre-clinical swine model of ischemic heart disease, we showed that daily administration of ubiquinone (coenzyme Q10, CoQ10) enhances the antioxidant status of mitochondria within chronically ischemic heart tissue, potentially via a PGC1α-dependent mechanism. In a randomized controlled trial, among high-risk patients undergoing elective vascular surgery, we showed that NT Pro-BNP levels are an important means of risk-stratification during the perioperative period and can be lowered with administration of CoQ10 (400 mg/day) for 3 days prior to surgery. The review provides background information for the role of oxidant stress and inflammation during high-risk operations and the potential novel application of ubiquinone as a preoperative antioxidant therapy that might reduce perioperative adverse cardiovascular outcomes.

Pro-Con Debate: Cardiac Troponin Measurement as Part of Routine Follow-up of Myocardial Damage Following Noncardiac Surgery

“…Troponin is not specific for myocardial ischemia or infarction, but it is the result of a broad and multifactorial dysfunction that might occur during the complex and unique perioperative period (Figure ). [63][64][65] Its elevation might merely signify worse outcome and not causation. Further research into postoperative patients with elevated troponin levels should look beyond the narrow scope of ischemia/ cardiologist consultation.…”

Novel Therapeutic Approaches Enhance PGC1-alpha to Reduce Oxidant Stress-Inflammatory Signaling and Improve Functional Recovery in Hibernating Myocardium

“…Pioglitazone, a PPAR-gamma receptor agonist, increased PGC1-alpha and mitochondrial antioxidant protein expression in a porcine model of hibernating myocardium [ 74 ]. Using a similar model, administration of dietary CoQ10, a key component of the electron transport chain (ETC), has been shown to increase the expression of PGC1-alpha, enhance mitochondrial biogenesis, and reduce NT-pro BNP levels, a marker of myocardial injury [ 75 , 76 , 77 ]. These results suggest that noninvasive therapies could be used to enhance PGC1-alpha signaling and might reduce cell injury in hibernating myocardium.…”

The Use of Coenzyme Q10 in Cardiovascular Diseases

“…NT-proBNP levels predict adverse post-vascular surgery events. It has been demonstrated that preoperative administration of CoQ10 for 3 days prior to the elective vascular surgical procedure lowers perioperative NT-proBNP levels [ 30 , 76 ].…”