In recent years, two clinical studies have demonstrated that LC supplementation (20 mg/kg) can reduce the level of CRP in patients on hemodialysis [10,11]. Another two clinical studiesprovided the hemodialysis patients with LC supplementation at dose of 1000 mg/d for 12 wk, and the level of inflammation markers, such as serum amyloid A, showed a significant decreaseof 32% (P < 0.01) [13], CRP and IL-6 showed a significant decrease of 29% (P < 0.05) and 61% (P < 0.001), respectively [12]. However, it has been reported that LC supplementation at dose of 2000 mg/d had no significant effect on the levels of inflammation markers in healthy individuals [33]. This lack of an effect in healthy individuals may be caused by the fact that they do nothave high levels of inflammation. Of the participants in the present study, 54% had a high inflammation status according to CRP levels (1 mg/L), 49% according to IL-6 levels (0.5 pg/mL),and 59% according to TNF-a levels (1.4 pg/mL). On average, >50% of our participants with CAD showed a high inflammation status. After 12 wk, LC supplementation at dose of 1000 mg/dsignificantly reduced the levels of CRP by 10%, IL-6 by 17%, and TNF-a by 6%, respectively, compared with baseline. Two clinical studies [34,35] showed some clinical benefits in a lower dose of LC supplementation (500 mg/d) in patients with migraine and those on chronic hemodialysis, but these studies did not examine the antiinflammatory effect and not used LC supplementation alone. Atherosclerosis is considered a chronic inflammatory disease; to lower the inflammation status in CAD, we suggest that LC supplementation at dose of 1000 mg/d may suppress the inflammation response in CAD, especially in those with a high inflammation and oxidative stress. However, further study is worthwhile to investigate an antiinflammation effect with a lower dose of LC supplementation combined with other antioxidantvitamins in patients with CAD. A recent review suggested that LC supplementation (500–1000 mg/d) could be initiated in participants with a lower LC reference value (20 mmol/L) [36]. The main functions of LC are esterified and transport long-chain fatty acids through the
mitochondrial membrane [6,7]. When fatty acid oxidation is impaired, acyl-coenzyme A may accumulate and deplete the coenzyme A intramitochondrial pool, causing a generalized
mitochondrial dysfunction and multiorgan failure [36]. Although our patients with CAD did not have carnitine depletion at baseline (<20 mmol/L), inflammation status was signifi-
cantly decreased after 12 wk of LC supplementation at dose of 1000 mg/d. Many clinical studies have reported no major clinical toxicity after a higher LC supplementation (2000–4000 mg/d) [37–40]. A well-known study reported that a higher LC level (>45.1 mmol/L) may increase the risk for cardiovascular disease [41], although these results are controversial [42]. The administered dose of LC (1000 mg/d) in the present study was within dietary supplementation
dose (the Ministry of Health and Welfare in Taiwan recommends a daily dietary intake of 2000 mg of LC). As the dose of LC supplementation (1000 mg/d) was not a pharmacologic dose, it can be expected that LC would not promote atherosclerosis or compromise cardiovascular health [42]. In this study, we provided patients with CAD with LC at a dose of 1000 mg/d divided into two doses (500 mg twice daily) and there were no clinically significant changes in the participants’ vital signs and hematologic values were within the normal ranges (such as
blood urea nitrogen, creatinine, glutamic oxaloacetic transaminase,
and glutamic pyruvate transaminase) after 12 wk
supplementation; this result means that LC at a dose of 1000
mg/d had no renal or liver toxicity. There were no serious adverse
events, no complaints of side effects such as nausea and vomiting
[43], and no withdrawals due to adverse events. Based on the
results, we support that LC at dose of 1000 mg/d had a protective
effect on patients with CAD.
There are two limitations of the present study that should be
mentioned. First, the number of participants was small, although
we did recruit more participants than expected. Second, this
study was designed using daily LC supplementation for only 12
wk. Larger and longer intervention studies are required to better
explore this potential CAD therapy.
In conclusion, we have demonstrated that LC supplementation
at a dose of 1000 mg/d significantly reduced inflammation
status in patients with CAD. LC has an antiinflammatory effect in
CAD that could be attributed to its role as an antioxidant.
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