Effects of lifestyle modification on oxidized LDL, reactive oxygen species production and endothelial cell viability in patients with coronary artery disease Suphot Srimahachota a , Rattiporn Wunsuwan b , Atchasai Siritantikorn c , Chanchai Boonla b , Suttirak Chaiwongkarjohn b , Piyaratana Tosukhowong b, ⁎ a Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10130, Thailand b Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10130, Thailand c Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10130, Thailand abstract article info Article history: Received 14 December 2009 Received in revised form 19 March 2010 Accepted 14 April 2010 Available online 21 April 2010 Keywords: Coronary artery disease Lifestyle modification Oxidized LDL Reactive oxygen species Human coronary artery endothelial cell Objectives: We evaluated the effects of lifestyle modification (LM) on lipid profile, oxidative stress and serum-stimulated human coronary artery endothelial cell (HCAEC) viability in coronary artery disease (CAD) patients after 6 months. Design and methods: Thirty patients with CAD were randomly assigned to LM intervention (n = 15) and usual care control (n = 15) groups. LM-intervened patients were instructed to consume low-fat, high- antioxidants and fiber diets. Moderate exercise and stress management were also advised. Group support to maintain patients' compliance was applied. Results: Serum cholesterol, triglyceride, oxidized LDL and protein carbonyl were decreased in LM group. Serum triglyceride was increased in control group. HCAEC viability was increased, while intracellular reactive oxygen species was decreased, by serum from the LM group. Conclusion: LM is capable of improving lipid profile, reducing oxidative stress and increasing HCAEC survival in the patients with CAD, hence lowering a risk for the future cardiovascular event. © 2010 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved. Introduction Coronary artery disease (CAD) is one of the life-threatening diseases in all countries [1]. In 2004, the WHO reported that CAD is the leading cause of death with an estimation of 7.20 million people (12.2% of all death) died from the disease. Dyslipidemia, hypertension, obesity, diabetes mellitus, metabolic syndrome, smoking and sedentary lifestyle are well-known risk factors for CAD [2–7]. Dyslipidemia defined as increases in circulating total cholesterol, triglyceride, low-density lipoprotein (LDL) and decrease in high-density lipoprotein (HDL), is a prerequisite event in the development of atherosclerosis. It is well recognized that LDL oxidized by free radicals, called oxidized LDL (oxLDL), plays a critical role in the formation and progression of atherosclerotic plaques [8]. Increased plasma oxLDL is documented in CAD patients, and it is an independent predictor of developing cardiac events [9]. A decade ago, lifestyle modification (LM) was introduced as an alter- native treatment for CAD in order to reduce mortality and improve quality of life of the patients. The LM approach basically focuses on dietary control, optimal exercise, weight reduction and stress manage- ment, aiming at normalization of the CAD risk factors. Amelioration of metabolic CAD risk factors by LM has been demonstrated in patients with metabolic syndrome [10]. In obese adults, LM effectively reduces body weight and markers of vascular inflammation and insulin resis- tance [11] as well as decreases metabolic CAD risk factors [12]. Intervention of LM is also capable of improving cardiovascular risk indices in HIV-infected patients with metabolic syndrome [13]. We previously reported that short-term intensive LM program increased circulating antioxidants and reduced oxidative stress in patients with CAD [14]. A short-term diet and exercise intervention (3 weeks) signif- icantly reduced serum lipids and body mass index (BMI) in diabetic men, and their sera were shown to reduce reactive oxygen species (ROS) production in human coronary artery endothelial cells (HCAECs) [15]. Also in metabolic syndrome men, serum-stimulated ROS production in HCAECs was decreased after three-week diet and exercise intervention [16]. Hitherto, the effects of lifestyle change on serum oxLDL and intra- cellular production of ROS in CAD patients have not been investigated. We aimed to evaluate the efficacy of LM intervention in ame- liorating dyslipidemia and oxidative stress in CAD patients. Further- more, an in vitro model was employed to examine the effects of sera from LM-intervened patients on HCAECs survival and ROS production. Patients, materials and methods Participants Sixty patients with CAD admitted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, were initially recruited for the study. The Clinical Biochemistry 43 (2010) 858–862 ⁎ Corresponding author. Fax: +66 2 2564482. E-mail address: piyaratana_t@yahoo.com (P. Tosukhowong). 0009-9120/$ – see front matter © 2010 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.clinbiochem.2010.04.056 Contents lists available at ScienceDirect Clinical Biochemistry journal homepage: www.elsevier.com/locate/clinbiochem