Antioxidant Profile and Early Outcome in Stroke Patients

Abstract

Background and Purpose-Experimental studies provide evidence of an association between ischemic stroke and increased oxidative stress, but data in humans are still limited and controversial. The purpose of this study was to investigate the time course of plasma antioxidant changes in ischemic stroke patients. Methods-Plasma antioxidants, including water-soluble (vitamin C and uric acid) and lipid-soluble (vitamins A and E) compounds as well as antioxidant enzyme activities in plasma (superoxide dismutase [SOD] and glutathione peroxidase) and erythrocytes (SOD), were measured by high-performance liquid chromatography (antioxidant vitamins) and by spectrophotometry (antioxidant enzymes) in 38 subjects (25 men and 13 women aged 77.2Ϯ7.9 years) with acute ischemic stroke of recent onset (Ͻ24 hours) on admission, after 6 and 24 hours, and on days 3, 5, and 7. Antioxidant levels in patients on admission were compared with those of age-and sex-matched controls. Results-Mean antioxidant levels and activities in patients on admission were lower than those of controls and showed a gradual increase over time. Patients with the worst early outcome (death or functional decline) had higher vitamin A and uric acid plasma levels and lower vitamin C levels and erythrocyte SOD activity than those who remained functionally stable. Conclusions-These results suggest that the majority of antioxidants are reduced immediately after an acute ischemic stroke, possibly as a consequence of increased oxidative stress. A specific antioxidant profile is associated with a poor early outcome. (Stroke. 2000;31:2295-2300.)

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

“…A recent study showed that in type 2 diabetic subjects elevated plasma UA levels were associated with increased arterial stiffness, which is a well-recognised cardiovascular risk factor [16]. Several studies in the general population showed an effect of serum UA levels on prediction of stroke outcomes [17][18][19]. Two studies have showed that elevated levels of UA were independently associated with an increased risk of early death after acute stroke [17,18].…”

Antioxidant supplementation enhances antioxidant capacity and mitigates oxidative damage following acute ischaemic stroke

“…A study by Leinonen et al (2000) reported an association between the plasma concentration of ascorbic acid and a-tocopherol and the degree of neurological impairment after ischaemic stroke . Cherubini et al (2000) also found evidence of reduced plasma antioxidant concentrations in ischaemic stroke patients and that higher plasma vitamin A and uric acid concentrations and lower plasma ascorbic acid concentrations and erythrocyte superoxide dismutase activity were associated with poor early clinical outcome. There is also some recent evidence of an association between oxidative damage and tissue inflammation as measured by C-reactive proteins (CRPs) in subjects with stroke disease (Gariballa et al, 2002).…”

“…The same study demonstrated an association between plasma total antioxidant activity and the volume of ischaemic cerebral infarction and the degree of subsequent neurological impairment. Another study of 38 ischaemic stroke patients and age and sex-matched controls reported reduced plasma antioxidant concentrations in stroke patients compared with controls and showed an association between poor antioxidant status and poor clinical outcome (Cherubini et al, 2000). Furthermore, Polidori et al (1998) reported a significant positive association between plasma lipid hydroperoxide concentration and the National Institute of Health Stroke Scale, and a significant negative correlation with the Glasgow Coma Scale (Polidori et al, 1998).…”

“…There is evidence that free radical production is an important mechanism of brain injury after exposure to ischaemia and reperfusion (Traystman et al, 1991). While it is not possible to make direct measurements of antioxidant activity and oxidant damage in this target tissue, concentrations of antioxidants and products of oxidative damage in plasma have proved informative in other studies of stroke (Cherubini et al, 2000;Leinonen et al, 2000).…”

“…This effect is enhanced by poor a-tocopherol (vitamin E) and ascorbic acid (vitamin C) status (Cooper et al, 1980), and can be mitigated by supplementation with vitamin E (Yoshida et al, 1984). Recent studies in humans have reported an association between the plasma concentration of ascorbic acid and a-tocopherol and early clinical outcome after acute ischaemic stroke (Cherubini et al, 2000;Leinonen et al, 2000). A study by Leinonen et al (2000) reported an association between the plasma concentration of ascorbic acid and a-tocopherol and the degree of neurological impairment after ischaemic stroke .…”