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The Clinical Use of N-Acetylcysteine in Cardiology

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The Therapeutic Use of N-Acetylcysteine (NAC) in Medicine

Abstract

N-acetylcysteine (NAC) may be best known for its role in the treatment for acetaminophen toxicity, but it’s well-documented antioxidant, antiplatelet, and vasodilatory effects have prompted multiple studies of its potential use in the treatment of several cardiac disease. The most prominent clinical application of NAC related to the cardiovascular diseases has been in the prevention of contrast-induced nephrotoxicity after coronary angiography/intervention (discussed in the chapter on applications of NAC in renal disease), but studies of its role as an adjunct to nitrate therapy and in the treatment of hypertension and acute myocardial infarction are significant and provocative. NAC has been studied for its potential protective effects after cardiac surgery regarding its potentially protective effects against acute postoperative renal failure and myocardial injury and in reducing postoperative atrial fibrillation. Studies of NAC use in hypertension and as an adjunct to nitrates for angina have focused on its ability to improve nitric oxide metabolism by potentiating its vasodilatory effects and limiting nitrate tolerance. Studies of its use in other cardiac conditions focus on its antioxidant effects, ability to be a free radical scavenger, and anti-inflammatory effects. Despite multiple individual studies showing positive results, NAC has yet to be established as a therapeutic agent for any of these cardiac conditions. Some of the issues limiting its widespread application are the variation in trial design and dosing schedules as well as failure of larger studies and meta-analysis to confirm its clinical utility. The limited benefits of NAC use that have been demonstrated in cardiac conditions need to be weighed against the potential for side effects and cost. Nevertheless, recent trials of its potential role in limiting infarct size and improving diastolic dysfunction hold promise and warrant further study. We believe that further well-designed larger controlled trials are needed to establish whether there is a clinical role for NAC therapy.

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Authors and Affiliations

  1. Tufts University School of Medicine, Baystate Medical Center, Springfield, MA, USA

    John P. Marenco

  2. Barrow Neurological Institute, Phoenix Children’s Hospital, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA

    Richard Eugene Frye

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  1. John P. Marenco
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  2. Richard Eugene Frye
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Correspondence to Richard Eugene Frye .

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Editors and Affiliations

  1. Barrow Neurological Institute, Phoenix Children’s Hospital, University of Arizona, College of Medicine – Phoenix, Phoenix, AZ, USA

    Richard Eugene Frye

  2. IMPACT SRC, Deakin University & Barwon Health, Geelong, VIC, Australia

    Michael Berk

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Marenco, J.P., Frye, R.E. (2019). The Clinical Use of N-Acetylcysteine in Cardiology. In: Frye, R., Berk, M. (eds) The Therapeutic Use of N-Acetylcysteine (NAC) in Medicine. Adis, Singapore. https://doi.org/10.1007/978-981-10-5311-5_16

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  • DOI: https://doi.org/10.1007/978-981-10-5311-5_16

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  • Publisher Name: Adis, Singapore

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  • Online ISBN: 978-981-10-5311-5

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