Selenium and Its Supplementation in Cardiovascular Disease—What do We Know?
<p>Roles of selenoproteins in the heart.</p> "> Figure 2
<p>Classes of selenoproteins and their putative functions.</p> "> Figure 3
<p>Systemic inflammatory response and treatment approaches in cardiac surgery (adapted from Hall [<a href="#B111-nutrients-07-03094" class="html-bibr">111</a>]).</p> ">
Abstract
:1. Introduction
2. The Role of Selenium and Selenoproteins in the Human Body
2.1. Glutathione Peroxidases
2.2. Thioredoxin Reductase (TrxR)
2.3. Thyroid Hormone Deiodinases (DIO)
2.4. Selenoprotein R (SelR, MsrB1)
2.5. Other Selenoproteins in the Heart
3. The Functional Role of Selenium in the Cardiovascular System
3.1. The Role of Selenium in the Development of Cardiomyopathy—Keshan Disease
3.2. The Role of Selenium and Selenoproteins in Myocardial I/R
3.3. The Role of Selenium in Cardiovascular Disease
3.3.1. Selenium as Biomarker
3.3.2. Selenium in Myocardial Infarction and Cardiovascular Stress
3.3.3. Prophylactic Selenium Supplementation
4. The Significance of Selenium in Cardiac Surgery
Ref. | Study Design | Population | Selenium Salt from and Dosing Regime | Outcomes |
---|---|---|---|---|
Leong 2010 [115] | Randomized controlled trial (double-blind) | Patients undergoing elective CABG and/or valve surgery n = 117 | Coenzyme Q10, magnesium orotate, lipoic acid, omega-3 fatty acids and selenium vs. placebo (approximately 2 months before and 1 month after surgery) | Metabolic therapy reduced plasma troponin I, 24 h postoperatively from 1.5 (1.2–1.8) (geometric mean 95% CI) μg L L−1, to 2.1 (1.8–2.6) μg L−1 (p = 0.003) and shortened the mean length of postoperative hospital stay by 1.2 days from 8.1 (7.5–8.7) to 6.9 (6.4–7.4) days (p = 0.004) and reduced hospital costs. Metabolic therapy was inexpensive and had no clinically significant side effects. |
Stoppe 2011 [113] | Prospective observational study | Patients scheduled for cardiac surgery with CPB n = 60 | - | Fifty patients exhibited a significant selenium deficiency already before surgery. In all patients, blood levels of selenium, copper, and zinc were significantly reduced after end of surgery when compared to preoperative values (selenium: 89.05 ± 12.65 to 70.84 ± 10.46 µg; zinc: 5.15 ± 0.68 to 4.19 ± 0.73 mg L−1; copper: 0.86 ± 0.15 to 0.65 ± 0.14 mg L−1; p < 0.001). Selenium concentrations at end of surgery were independently associated with the postoperative occurrence of multiorgan failure (p = 0.0026, odds ratio 0.8479, 95% confidence interval 0.7617 to 0.9440). |
Koszta 2012 [114] | Prospective observational study | Patients scheduled for cardiac surgery with CPB n = 197 | - | Selenium levels were significantly lower in non-survivors 102.2 ± 19.5 μg L−1 compared with survivors 111.1 ± 16.9 μg L−1 (p = 0.047), and the mean age, European System for Cardiac Operative Risk Evaluation (EuroSCORE) values, and troponin concentrations were significantly higher in the non-survivors. Lower selenium levels identified as a risk factor for postoperative mortality. |
Stoppe 2013 [116] | Prospective observational study | Patients scheduled for cardiac surgery with CPB n = 104 | Intravenous bolus of 2.000 μg selenium after induction of anesthesia and 1.000 μg selenium every day further during ICU stay | Preoperative sodium-selenite administration increased selenium blood concentrations to normal values on ICU admission, but failed to prevent a significant decrease of circulating selenium on the first postoperative day. |
Stevanovic 2014 [110] | Randomized controlled trial (comparison: Off- vs. on-pump CABG) | Patients undergoing elective CABG n = 40 | - | Both groups showed a comparable decrease of circulating selenium concentrations. Likewise, levels of oxidative stress and IL-6 were comparable in both groups. Selenium levels correlated with antioxidant capacity (GPx: r = 0.720; p < 0.001) and showed a negative correlation to myocardial damage (CK-MB: r = −0.571, p < 0.001). Low postoperative selenium levels had a high predictive value for the occurrence of any postoperative complication. |
Sustain CSX Trial 2014 [117] | Randomized controlled trial (double-blind) | Patients undergoing CABG plus valve surgery, multiple valve replacement surgery, patients with a high perioperative risk profile (≥5% EuroSCORE II). n = 1400 | Intravenous bolus of 2.000 μg selenium after induction of anesthesia and 1.000 μg selenium every day further during ICU stay | On-going, recruiting |
Haberthuer ClinicalTrials.gov Identifier: NCT01141556 | Randomized controlled trial (double-blind) | Elective all-cause cardiac surgery n = 410 | Loading dose of 4.000 μg, daily dosage of 1.000 μg of selenium vs. placebo | On-going, on analysis |
5. Future Directions and Therapeutic Implications
6. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Benstoem, C.; Goetzenich, A.; Kraemer, S.; Borosch, S.; Manzanares, W.; Hardy, G.; Stoppe, C. Selenium and Its Supplementation in Cardiovascular Disease—What do We Know? Nutrients 2015, 7, 3094-3118. https://doi.org/10.3390/nu7053094
Benstoem C, Goetzenich A, Kraemer S, Borosch S, Manzanares W, Hardy G, Stoppe C. Selenium and Its Supplementation in Cardiovascular Disease—What do We Know? Nutrients. 2015; 7(5):3094-3118. https://doi.org/10.3390/nu7053094
Chicago/Turabian StyleBenstoem, Carina, Andreas Goetzenich, Sandra Kraemer, Sebastian Borosch, William Manzanares, Gil Hardy, and Christian Stoppe. 2015. "Selenium and Its Supplementation in Cardiovascular Disease—What do We Know?" Nutrients 7, no. 5: 3094-3118. https://doi.org/10.3390/nu7053094