Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Francie van Zijl Drive, P.O. Box 19070, Tygerberg, 7505, South Africa.
Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, 7505, South Africa.
Am J Cardiovasc Drugs. 2018 Aug;18(4):283-298. doi: 10.1007/s40256-018-0275-2.
Heart failure is the leading cause of death in patients with diabetes. No treatment currently exists to specifically protect these patients at risk of developing cardiovascular complications. Accelerated oxidative stress-induced tissue damage due to persistent hyperglycemia is one of the major factors implicated in deteriorated cardiac function within a diabetic state. N-acetyl cysteine (NAC), through its enhanced capacity to endogenously synthesize glutathione, a potent antioxidant, has displayed abundant health-promoting properties and has a favorable safety profile.
An increasing number of experimental studies have reported on the strong ameliorative properties of NAC. We systematically reviewed the data on the cardioprotective potential of this compound to provide an informative summary.
Two independent reviewers systematically searched major databases, including PubMed, Cochrane Library, Google scholar, and Embase for available studies reporting on the ameliorative effects of NAC as a monotherapy or in combination with other therapies against diabetes-associated cardiovascular complications. We used the ARRIVE and JBI appraisal guidelines to assess the quality of individual studies included in the review. A meta-analysis could not be performed because the included studies were heterogeneous and data from randomized clinical trials were unavailable.
Most studies support the ameliorative potential of NAC against a number of diabetes-associated complications, including oxidative stress. We discuss future prospects, such as identification of additional molecular mechanisms implicated in diabetes-induced cardiac damage, and highlight limitations, such as insufficient studies reporting on the comparative effect of NAC with common glucose-lowering therapies. Information on the comparative analysis of NAC, in terms of dose selection, administration mode, and its effect on different cardiovascular-related markers is important for translation into clinical studies.
NAC exhibits strong potential for the protection of the diabetic heart at risk of myocardial infarction through inhibition of oxidative stress. The effect of NAC in preventing both ischemia and non-ischemic-associated cardiac damage is also of interest. Consistency in dose selection in most studies reported remains important in dose translation for clinical relevance.
心力衰竭是糖尿病患者死亡的主要原因。目前尚无专门针对易发生心血管并发症的此类患者的治疗方法。持续性高血糖引起的氧化应激加速导致的组织损伤是糖尿病状态中心脏功能恶化的主要因素之一。N-乙酰半胱氨酸（NAC）通过增强内源性合成谷胱甘肽（一种有效的抗氧化剂）的能力，具有丰富的促进健康的特性和良好的安全性。
越来越多的实验研究报告了 NAC 的强大改善特性。我们系统地回顾了关于该化合物的心脏保护潜力的数据，以提供信息性总结。
两名独立审查员系统地搜索了主要数据库，包括 PubMed、Cochrane 图书馆、Google Scholar 和 Embase，以查找报告 NAC 作为单一疗法或与其他治疗糖尿病相关心血管并发症的联合疗法的改善效果的可用研究。我们使用 ARRIVE 和 JBI 评估指南来评估审查中包含的各个研究的质量。由于纳入的研究存在异质性，且缺乏随机临床试验的数据，因此无法进行荟萃分析。
大多数研究支持 NAC 对多种糖尿病相关并发症的改善潜力，包括氧化应激。我们讨论了未来的前景，例如鉴定更多与糖尿病引起的心脏损伤相关的分子机制，并强调了一些局限性，例如缺乏报告 NAC 与常见降糖治疗的比较效果的研究。关于 NAC 的比较分析的信息，包括剂量选择、给药方式及其对不同心血管相关标志物的影响，对于转化为临床研究非常重要。
NAC 通过抑制氧化应激，对易发生心肌梗死的糖尿病心脏具有强大的保护潜力。NAC 预防缺血和非缺血相关心脏损伤的作用也很有趣。大多数报告的研究中剂量选择的一致性对于临床相关性的剂量转化仍然很重要。
