Using machine learning-based algorithms to construct cardiovascular risk prediction models for Taiwanese adults based on traditional and novel risk factors.

OBJECTIVE: To develop and validate machine learning models for predicting coronary artery disease (CAD) within a Taiwanese cohort, with an emphasis on identifying significant predictors and comparing the performance of various models. METHODS: This study involved a comprehensive analysis of clinical, demographic, and laboratory data from 8,495 subjects in Taiwan Biobank (TWB) after propensity score matching to address potential confounding factors. Key variables included age, gender, lipid profiles (T-CHO, HDL_C, LDL_C, TG), smoking and alcohol consumption habits, and renal and liver function markers. The performance of multiple machine learning models was evaluated. RESULTS: The cohort comprised 1,699 individuals with CAD identified through self-reported questionnaires. Significant differences were observed between CAD and non-CAD individuals regarding demographics and clinical features. Notably, the Gradient Boosting model emerged as the most accurate, achieving an AUC of 0.846 (95% confidence interval [CI] 0.819-0.873), sensitivity of 0.776 (95% CI, 0.732-0.820), and specificity of 0.759 (95% CI, 0.736-0.782), respectively. The accuracy was 0.762 (95% CI, 0.742-0.782). Age was identified as the most influential predictor of CAD risk within the studied dataset. CONCLUSION: The Gradient Boosting machine learning model demonstrated superior performance in predicting CAD within the Taiwanese cohort, with age being a critical predictor. These findings underscore the potential of machine learning models in enhancing the prediction accuracy of CAD, thereby supporting early detection and targeted intervention strategies. TRIAL REGISTRATION: Not applicable.

Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study.

BACKGROUND: Metabolic acidosis is a major complication of critical illness. However, its current epidemiology and its treatment with sodium bicarbonate given to correct metabolic acidosis in the ICU are poorly understood. METHOD: This was an international retrospective observational study in 18 ICUs in Australia, Japan, and Taiwan. Adult patients were consecutively screened, and those with early metabolic acidosis (pH < 7.3 and a Base Excess < -4 mEq/L, within 24-h of ICU admission) were included. Screening continued until 10 patients who received and 10 patients who did not receive sodium bicarbonate in the first 24 h (early bicarbonate therapy) were included at each site. The primary outcome was ICU mortality, and the association between sodium bicarbonate and the clinical outcomes were assessed using regression analysis with generalized linear mixed model. RESULTS: We screened 9437 patients. Of these, 1292 had early metabolic acidosis (14.0%). Early sodium bicarbonate was given to 18.0% (233/1292) of these patients. Dosing, physiological, and clinical outcome data were assessed in 360 patients. The median dose of sodium bicarbonate in the first 24 h was 110 mmol, which was not correlated with bodyweight or the severity of metabolic acidosis. Patients who received early sodium bicarbonate had higher APACHE III scores, lower pH, lower base excess, lower PaCO2, and a higher lactate and received higher doses of vasopressors. After adjusting for confounders, the early administration of sodium bicarbonate was associated with an adjusted odds ratio (aOR) of 0.85 (95% CI, 0.44 to 1.62) for ICU mortality. In patients with vasopressor dependency, early sodium bicarbonate was associated with higher mean arterial pressure at 6 h and an aOR of 0.52 (95% CI, 0.22 to 1.19) for ICU mortality. CONCLUSIONS: Early metabolic acidosis is common in critically ill patients. Early sodium bicarbonate is administered by clinicians to more severely ill patients but without correction for weight or acidosis severity. Bicarbonate therapy in acidotic vasopressor-dependent patients may be beneficial and warrants further investigation.

The risks of ubiquinone and ß-carotene deficiency and metabolic disorders in patients with oral cancer.

BACKGROUND: Cancer development is mediated by oxidative stress and inflammation, which may correlate with metabolic disorders. The aim of this study was to evaluate antioxidant vitamins status and metabolic parameters in patients with oral cancer according to tumor-node-metastasis (TNM) stages. METHODS: A total of 194 patients with oral cancer were enrolled in this study. The patients were stratified for four groups according to cancer stages and that the statistics are comparisons across these groups. The levels of antioxidant vitamins (ubiquinone, ß-carotene, vitamin A and E), metabolic parameters, oxidative stress, antioxidant enzymes activity, and inflammatory markers were measured. RESULTS: More than half of the subjects had high blood pressure, central obesity, hyperglycemia, and hyperlipidemia regardless of TNM stage. With regard to antioxidant vitamins status, 46 and 94% of patients had ß-carotene and ubiquinone deficiency, respectively. Patients in T3 and T4 stages had significantly lower antioxidant enzyme (catalase, p = 0.03) activity and higher inflammatory markers levels (high sensitivity C-reactive protein and interleukin-6, p < 0.01) than patients in the other stages. In addition, the level of ß-carotene was negatively associated with waist circumference, and ubiquinone was positively associated with the level of high-density lipoprotein cholesterol (p < 0.05). Higher ß-carotene and ubiquinone levels were negatively associated with hypertriglyceridemia and the risk of metabolic syndrome (p < 0.05). CONCLUSIONS: A high proportion of patients with oral cancer had ubiquinone or ß-carotene deficiency and metabolic disorders. The level of ubiquinone or ß-carotene was negatively associated with the risk of central obesity, hypertriglyceridemia, and metabolic syndrome. Since patients with oral cancer suffer from high oxidative stress and inflammation (particularly in the T3 and T4 stages), supplementation with antioxidant vitamins such as ubiquinone or ß-carotene could be preferentially applied.

Antiplatelet agents and anticoagulants increased the bleeding risk of bedside percutaneous dilational tracheostomy in critically ill patients.

BACKGROUND: The main objective of this study was to investigate the safety of bedside percutaneous dilational tracheostomy (PDT) by pulmonologists in critically ill patients, and the factors associated with complications resulting from PDT. METHODS: We retrospectively enrolled critically ill patients who had undergone bedside PDT in the intensive care units (ICUs) and respiratory care center from February 2016 to December 2018. RESULTS: A total of 312 patients were included for analysis, with a mean age of 69.6 ± 17.7 years. Two hundred and eight of the patients were male (66.7%). The mean acute physiology and chronic health evaluation II score was 25.3 ± 6.3, and the mean body mass index was 22.4 ± 4.2. Most of the patients were intubated due to respiratory disorders (51.3%). Fifty-six patients (17.9%) received antiplatelet agents or an anticoagulant regularly prior to PDT. All enrolled patients were undergone bedside PDT successfully. The total complication rate of PDT was 14.4%. Patients who took antiplatelet agents or anticoagulants regularly before PDT had a higher risk of bleeding than patients who went without (26.8% versus 7.0%, adjusted odds ratio 4.93 [95% f 2.16-11.25], p < 0.001). Finally, a longer length of intubation resulted in a higher probability in the length of ICU stay being ≧28 days (adjusted odds ratio 1.11 [95% CI 1.08-1.14], p < 0.001). CONCLUSION: Our study demonstrated that it was feasible for pulmonologists to perform bedside PDT in critically ill patients. However, antiplatelet agents and anticoagulants use increased the risk of bleeding in PDT patients.

Miliary Tuberculosis-Related Acute Respiratory Distress Syndrome Complicated with Hemophagocytic Lymphohistiocytosis Syndrome.

Acute respiratory distress syndrome (ARDS) and hemophagocytic lymphohistiocytosis (HLH) are accompanied with poor outcome and high mortality when miliary tuberculosis is a causative pathogen for both of them. A patient complicated with ARDS and HLH is unusual in critical care, and few case reports are present in PudMed. Besides, the relationship between HLH and ARDS is still unknown and has not been reviewed in the literature. In this report, we present the case of a 74-year-old Taiwanese woman suffering from pulmonary tuberculosis and miliary tuberculosis, and she developed ARDS and HLH on the 3rd day after admission. We arranged serial laboratory examination, various serum markers, bone marrow aspiration, and bronchoscopy with alveolar lavage for survey; we prescribed empirical antibiotics and antituberculosis medication soon after alveolar lavage showing positive acid-fast stain. She was extubated on hospital day 31 and discharged on hospital day 73. In conclusion, early diagnosis and intervention for underlying disease and intensive bundle care for multiorgan failure are crucial for both ARDS and HLH.

Ruptured Multifocal Hepatic Aneurysms in a Woman with Systemic Lupus Erythematosus Successfully Treated with Transcatheter Arterial Embolization: A Case Report and Literature Review.

To present a first reported case of ruptured multifocal hepatic aneurysms in a woman with systemic lupus erythematosus (SLE) who was treated successfully with transcatheter arterial embolization (TAE) in literature, similar cases in the previous English literature were also reviewed and analyzed to summarize the clinical manifestations, management, and outcome in these patients. The data were gathered from the medical record and literature reviews were searched from PudMed. In our review, patients with SLE-related hepatic aneurysms were often middle-aged females. Most of them presented with acute abdominal pain and hypotension. The overall mortality rate was 50%, but it was lower (12.5%) in patients who received TAE. Both TAE and surgical intervention are used to treat SLE-related hepatic aneurysms. Our review raised concerns about early detection, diagnosis, and prompt intervention of possible hepatic aneurysm rupture in patients with SLE.

Optimal Time and Target for Evaluating Energy Delivery after Adjuvant Feeding with Small Bowel Enteral Nutrition in Critically Ill Patients at High Nutrition Risk.

Small bowel enteral nutrition (SBEN) may improve nutrient delivery to critically ill patients intolerant of gastric enteral nutrition. However, the optimal time and target for evaluating SBEN efficacy are unknown. This retrospective cohort study investigates these parameters in 55 critically ill patients at high nutrition risk (modified NUTRIC score ≥ 5). Daily actual energy intake was recorded from 3 days before SBEN initiation until 7 days thereafter. The energy achievement rate (%) was calculated as follows: (actual energy intake/estimated energy requirement) × 100. The optimal time was determined from the day on which energy achievement rate reached >60% post-SBEN. Assessment results were as follows: median APACHE II score, 27; SOFA score, 10.0; modified NUTRIC score, 7; and median time point of SBEN initiation, ICU day 8. The feeding volume, energy and protein intake, and achievement rate (%) of energy and protein intake increased significantly after SBEN (p < 0.001). An energy achievement rate less than 65% 3 days after SBEN was significantly associated with increased mortality after adjusting for confounding factors (odds ratio, 4.97; 95% confidence interval, 1.44⁻17.07). SBEN improves energy delivery in critically ill patients who are still at high nutrition risk after 1 week of stomach enteral nutrition.

Targeted Energy Intake Is the Important Determinant of Clinical Outcomes in Medical Critically Ill Patients with High Nutrition Risk.

The clinical conditions of critically ill patients are highly heterogeneous; therefore, nutrient requirements should be personalized based on the patient's nutritional status. However, nutritional status is not always considered when evaluating a patient's nutritional therapy in the medical intensive care unit (ICU). We conducted a retrospective cross-sectional study to assess the effect of ICU patients' nutrition risk status on the association between energy intake and clinical outcomes (i.e., hospital, 14-day and 28-day mortality). The nutrition risk of critically ill patients was classified as either high- or low-nutrition risk using the modified Nutrition Risk in the Critically Ill score. There were 559 (75.3%) patients in the high nutrition risk group, while 183 patients were in the low nutrition risk group. Higher mean energy intake was associated with lower hospital, 14-day and 28-day mortality rates in patients with high nutrition risk; while there were no significant associations between mean energy intake and clinical outcomes in patients with low nutrition risk. Further examination of the association between amount of energy intake and clinical outcomes showed that patients with high nutrition risk who consumed at least 800 kcal/day had significantly lower hospital, 14-day and 28-day mortality rates. Although patients with low nutrition risk did not benefit from high energy intake, patients with high nutrition risk are suggested to consume at least 800 kcal/day in order to reduce their mortality rate in the medical ICU.

Relationship of Oxidative Stress, Inflammation, and the Risk of Metabolic Syndrome in Patients with Oral Cancer.

Oral cancer is the fifth leading cause of cancer death in Taiwan, and the prevalence of metabolic syndrome (MS) has also increased globally. The purpose of this study was to investigate the correlations between the components of MS and oxidative stress and inflammation in patients with oral cancer based on their areca-nut-chewing habits. Two hundred patients diagnosed with oral cancer were recruited, and metabolic parameters, oxidative stress, antioxidant enzyme activities, and inflammatory markers were measured. 63% of the subjects have concomitant MS. Subjects who had an areca-nut-chewing habit had significantly higher levels of fasting glucose (p = 0.04), oxidative stress (p = 0.02), and inflammatory markers (p = 0.02) than those who never chewed. High-density lipoprotein-cholesterol level (p = 0.03) and superoxidase dismutase activity (p = 0.02) were significantly lower in individuals who had chewed or were currently chewers. Areca-nut-chewing habit was associated with the increased risks for MS and hypertriglyceridemia; the components of MS were positively correlated with oxidative stress and inflammation. In conclusion, patients with oral cancer who had an areca-nut-chewing habit exhibited higher levels of oxidative stress and inflammation, which might be related to an increased risk of MS.

Effect of liquid ubiquinol supplementation on glucose, lipids and antioxidant capacity in type 2 diabetes patients: a double-blind, randomised, placebo-controlled trial.

Ubiquinone is a lipid antioxidant, and a novel liquid ubiquinol (a hydro-soluble, reduced form of coenzyme Q10) supplement was recently developed. The purpose of this study was to examine the levels of glucose, lipids and antioxidant capacity of type 2 diabetes patients after liquid ubiquinol supplementation. This study was designed as a randomised, double-blind, placebo-controlled trial. In all, fifty participants were randomly assigned to a placebo (n 25) or liquid ubiquinol (100 mg/d, n 25) group, and the intervention lasted for 12 weeks. Plasma coenzyme Q10, glucose homoeostasis parameters, lipid profiles, oxidative stress and antioxidative enzyme activities were measured during the study. After 12 weeks of supplementation, glyco Hb (HbA1c) value was significantly decreased in the liquid ubiquinol group (P=0·03), and subjects in the liquid ubiquinol group had significantly lower anti-glycaemic medication effect scores (MES) compared with those in the placebo group (P=0·03). The catalase (P<0·01) and glutathione peroxidase (P=0·03) activities were increased significantly after supplementation. Plasma coenzyme Q10 was correlated with the insulin level (P=0·05), homoeostatic model assessment-insulin resistance (P=0·07), quantitative insulin sensitivity check index (P=0·03) and the anti-hyperglycaemic agents' MES (P=0·03) after supplementation. Lipid profiles did not change after supplementation; however, the subjects in the placebo group had a significantly lower level of HDL-cholesterol after 12 weeks of intervention. In conclusion, oral intake of 100 mg/d liquid ubiquinol might benefit type 2 diabetes patients by increasing antioxidant enzyme activity levels, reducing HbA1c levels and maintaining HDL-cholesterol levels.

Young-Adult Polycystic Kidney Disease is Associated with Major Cardiovascular Complications.

Background: Patients with polycystic kidney disease (PKD) might have a risk of cardiovascular diseases because several cardiovascular risk factors are occasionally associated with PKD patients. Data on the association between PKD and the risk of cardiovascular events, including acute coronary syndrome (ACS), stroke, and congestive heart failure (CHF), are scant. Methods: Patients aged ≥20 years who were newly diagnosed with PKD (International Classification of Diseases, Ninth Revision, Clinical Modification codes 753.12 and 753.13) between 2000 and 2011 were selected as a PKD cohort (N = 5157). The association between PKD and cardiovascular events was analyzed. Results: We randomly selected a comparison cohort of people without PKD, who were frequency-matched by sex, age, and index date of diagnosis. At the end of 2011, the PKD cohort had a 1.40-fold greater incidence of ACS compared with the comparison cohort (8.59 vs. 6.17 per 1000 person-years), in addition to a 1.40-fold greater incidence of stroke, a 1.49-fold greater incidence of CHF, and a 1.64-fold greater incidence of mortality. Conclusions: This retrospective cohort study shows that patients with PKD have an increased risk of cardiovascular events including ACS, stroke, and CHF as well as mortality, particularly in younger patients. Early identification is necessary to attenuate the risk of cardiovascular complications in patients with PKD.

Effects of L-carnitine supplementation on lipid profiles in patients with coronary artery disease.

BACKGROUND: L-carnitine (LC) plays an important physiologic role in lipid metabolism. To date, no clinical study has been performed to examine the effect of LC supplementation on the lipid status of coronary artery disease (CAD) patients. The aim of this study was to investigate the lipid lowering effects of LC supplementation (1000 mg/d) in CAD patients. METHODS: CAD patients were identified by cardiac catheterization as having at least 50 % stenosis of one major coronary artery. Forty-seven subjects were recruited and randomly assigned to the placebo (n = 24) and to the LC (n = 23) groups. The intervention was administered for 12 weeks. The levels of LC, lipid profiles, and antioxidant enzyme activity (superoxide dismutase, SOD) were measured. RESULTS: The subjects in the LC group had significantly higher SOD activity (20.7 ± 4.2 versus 13.1 ± 2.9 U/mg of protein, P < 0.01), high density lipoprotein-cholesterol (1.34 ± 0.42 vs. 1.16 ± 0.24 mmol/L, HDL-C, P = 0.03), and apolipoprotein-A1 (Apo-A1, 1.24 ± 0.18 vs. 1.12 ± 0.13 g/L, P = 0.02) than those in the placebo group at week 12. Triglyceride (TG) level was slightly significantly reduced (1.40 ± 0.74 vs. 1.35 ± 0.62 mmol/L, P = 0.06) and the level of LC was negatively correlated with TG and apolipoprotein-B (Apo-B), and positively correlated with HDL-C and Apo-A1 after LC supplementation. Additionally, SOD activity was significantly negatively correlated with lipid profiles (total cholesterol, TG, and Apo-B) after supplementation. CONCLUSION: LC supplementation at a dose of 1000 mg/d showed significantly increased in HDL-C and Apo-A1 levels and a slight decrease in TG levels but no other changes in other lipids in CAD patients, and this lipid-lowering effect may be related to its antioxidant ability. Further studies should be conducted to define an optimal dose of LC for lipid-lowering in patients with CAD. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT01819701.

Prior statin use and the outcomes in patients with first-attack acute pancreatitis: A retrospective cohort study.

BACKGROUND: We investigated whether prior stain use before admission for a first-attack AP would reduce the severity and mortality rate of a first-attack of AP with a dose-response relationship. METHODS: We conducted a retrospective cohort study from a tertiary medical center's database in Taiwan. We evaluated the dose-response relationship between statin use and the first-attack of AP by defining the daily dose (DDD). The cumulative DDD (cDDD) was calculated as the sum of the dispensed DDD of any specific statin. The outcome measures in our study included the hospital mortality rate, duration of hospitalization, Ranson's score, computed tomography severity index (CTSI), and C-reactive protein (CRP) level. RESULTS: In our study, we enrolled 31 patients in statin group and 63 matched patients in control group. In the univariate analysis there was no significant difference between them with regard to the outcomes except the CTSI and serum calcium concentration. According to multivariate analysis the serum calcium concentration was significantly higher in the statin group, and the CTSI was lower in the statin group. In subgroup analysis we divided the statin group into two groups according to the cDDDs (<365days and >365days) and the results showed no significance in the demographic data, overall mortality rate, hospitalization days, CRP level, Ranson's score, or CTSI. CONCLUSION: Our study rejected the hypothesis that statins have beneficial effects on the clinical outcomes of patients with a first-attack of AP. However we demonstrated that statins have a positive effect on the CTSI.

Risk factors associated with end-stage renal disease (ESRD) in patients with atherosclerotic renal artery stenosis: a nationwide population-based analysis.

The aim of this study was to investigate the risk factors associated with end-stage renal disease (ESRD) in patients with atherosclerotic renal artery stenosis (ARAS). Information about the study participants was extracted from the National Health Insurance Research Database of Taiwan for the years 1999 through 2011. We conducted this retrospective cohort study of patients with ARAS to identify the potential risk factors associated with long-term renal outcomes. A total of 2184 patients with ARAS were enrolled, of whom 840 had ESRD and were classified as the study group, and 1344 patients who were without ESRD were included in the comparison cohort. After adjusting for related variables, univariable, and multivariable logistic regression analysis showed that ESRD was associated with higher Charlson-comorbidity index (CCI) score (adjusted odds ratio [OR] = 6.78, 95% CI = 4.59-10.0 for CCI = 2; adjusted OR = 20.0, 95% CI = 13.7-29.2 for CCI ≥3), diabetes (adjusted OR = 1.55, 95% CI = 1.24-1.93), hypertension (adjusted OR = 3.66, 95% CI = 2.36-5.66), and age 20 to 49-years old (adjusted OR = 2.14, 95% CI = 1.51-3.03). Moreover, our data showed that renal artery revascularization (RAR) was significantly associated with a lower risk of ESRD in ARAS patients (crude OR = 0.64, 95% CI = 0.50-0.84). Our study is the first to disclose that CCI score was significantly associated with the risk of ESRD in ARAS patients, and comorbid diseases including diabetes mellitus and hypertension significantly affect renal outcomes in patients with ARAS. Of note, our data showed that renal artery revascularization was associated with a lower risk of ESRD in ARAS patients in long-term follow-up.

Antiinflammatory effects of L-carnitine supplementation (1000 mg/d) in coronary artery disease patients.

OBJECTIVE: Inflammation mediators have been recognized as risk factors for the pathogenesis of coronary artery disease (CAD). The purpose of this study was to investigate the effect of L-carnitine supplementation (LC, 1000 mg/d) on inflammation markers in patients with CAD. METHODS: We enrolled 47 patients with CAD in the study. The patients with CAD were identified by cardiac catheterization as having <50% stenosis of one major coronary artery. The patients were randomly assigned to the placebo (n = 24) and LC (n = 23) groups and the intervention was administered for 12 wk. The levels of LC, antioxidant status (malondialdehyde and antioxidant enzymes activities), and inflammation markers (C-reactive protein [CRP], interleukin [IL]-6, and tumor necrosis factor [TNF]-α) were measured. RESULTS: Thirty-nine participants completed the study (19 placebo; 20 LC). After LC supplementation, the levels of inflammation markers were significantly reduced compared with the baseline (CRP, P < 0.01; IL-6, P = 0.03; TNF-α, P = 0.07) and those in the placebo group (CRP, P < 0.05; IL-6, P = 0.04; TNF-α, P = 0.03). The levels of inflammation markers were significantly negatively correlated with the levels of LC and antioxidant enzymes activities (P < 0.05). CONCLUSIONS: We suggest that LC supplementation, due to its antioxidant effects, may have potential utility to reduce inflammation in CAD.

Acetazolamide-related life-threatening hypophosphatemia in a glaucoma patient.

Acetazolamide-related hypophosphatemia leading to cardiac arrest is extremely rare. Herein we report a 78-year-old female glaucoma patient who developed general weakness and acute respiratory failure, followed by cardiac arrest 1 day after taking acetazolamide. The patient was successfully weaned from the ventilator after correction of hypophosphatemia and fully recovered. As acetazolamide was shown to have the potential to cause a lethal side effect in stable glaucoma, the risk of hypophosphatemia should be kept in mind by ophthalmologists. An examination of serum metabolic panels may be indicated in patients at risk of hypophosphatemia.

Effects of L-carnitine supplementation on oxidative stress and antioxidant enzymes activities in patients with coronary artery disease: a randomized, placebo-controlled trial.

BACKGROUND: Cardiovascular disease is the leading cause of death worldwide. Higher oxidative stress may contribute to the pathogenesis of coronary artery disease (CAD). The purpose of this study was to investigate the effect of L-carnitine (LC, 1000 mg/d) on the markers of oxidative stress and antioxidant enzymes activities in CAD patients. METHODS: We enrolled 47 CAD patients in the study. The CAD patients were identified by cardiac catheterization as having at least 50% stenosis of one major coronary artery. The subjects were randomly assigned to the placebo (n = 24) and LC (n = 23) groups. The intervention was administered for 12 weeks. The levels of serum LC, plasma malondialdehyde (MDA), and erythrocyte antioxidant enzymes activities [catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx)] were measured before and after intervention. RESULTS: Thirty-nine subjects completed the study (placebo, n = 19; LC, n = 20). After 12 weeks of LC supplementation, the level of MDA was significantly reduced (2.0 ± 0.3 to 1.8 ± 0.3 µmol/L, P = 0.02) and the level of LC (33.6 ± 13.6 to 40.0 ± 12.0 µmol/L, P = 0.04) and antioxidant enzymes activities [CAT (12.7 ± 5.5 to 13.1 ± 5.8 U/mg of protein, P = 0.02), SOD (14.8 ± 2.9 to 20.7 ± 5.8 U/mg of protein, P < 0.01), and GPx (20.3 ± 3.4 to 23.0 ± 3.1 U/mg of protein, P = 0.01)] were significantly increased. The level of LC was significantly positively correlated with the antioxidant enzymes activities (CAT, ß = 0.87, P = 0.02; SOD, ß = 0.72, P < 0.01). CONCLUSION: LC supplementation at a dose of 1000 mg/d was associated with a significant reduction in oxidative stress and an increase in antioxidant enzymes activities in CAD patients. CAD patients might benefit from using LC supplements to increase their anti-oxidation capacity. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT01819701.