Effects of Selenium Supplementation on Metabolic Status in Patients Undergoing for Coronary Artery Bypass Grafting (CABG) Surgery: a Randomized, Double-Blind, Placebo-Controlled Trial

  • Alireza Kamali
  • Elaheh Amirani
  • Zatollah AsemiEmail author


This study was carried out to evaluate the effects of selenium supplementation on glycemic control, lipid profiles, and biomarkers of inflammation and oxidative stress in patients undergoing for coronary artery bypass grafting (CABG) surgery. This randomized, double-blind, placebo-controlled trial was performed among 33 patients undergoing for CABG surgery, aged 40–85 years old. Subjects were randomly allocated into two groups to intake either 200 μg/day selenium supplements as selenium yeast (n = 17) or placebo (n = 16) for 4 weeks. Glycemic control, lipid profiles, and biomarkers of inflammation and oxidative stress were assessed at baseline and at the end of trial. After the 4-week intervention, selenium supplementation significantly decreased fasting plasma glucose (FPG) (β, 6.76 mg/dL; 95% CI, − 13.13, − 0.40; P = 0.03), insulin (β, − 1.14 μIU/mL; 95% CI, − 2.01, − 0.28; P = 0.01); homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (β − 0.35; 95% CI, − 0.62, − 0.08; P = 0.01); and total-/HDL-cholesterol ratio (β − 0.31; 95% CI, − 0.51, − 0.09; P = 0.008); and significantly increased HDL-cholesterol levels (β, 2.72 mg/dL; 95% CI, 0.89, 4.55; P = 0.005) compared with the placebo. Moreover, selenium supplementation led to a significant reduction in high-sensitivity C-reactive protein (hs-CRP) (β, − 0.68 mg/L; 95% CI, − 1.18, − 0.17; P = 0.01) and malondialdehyde (MDA) (β, − 0.27 μmol/L; 95% CI, − 0.47, − 0.07; P = 0.009), and a significant elevation in total glutathione (GSH) levels (β, 77.33 μmol/L; 95% CI, 56.11, 98.55; P < 0.001) compared with the placebo. Selenium supplementation did not affect other metabolic profiles. Overall, our study demonstrated that selenium supplementation for 4 weeks to patients undergoing for CABG surgery had beneficial effects on FPG, insulin, HOMA-IR, total-/HDL-cholesterol ratio, HDL-cholesterol, hs-CRP, GSH, and MDA levels, but did not affect other metabolic profiles. Clinical trial registration number: IRCT2017090533941N22.


Selenium Supplementation Metabolic status Coronary artery bypass grafting 


Authors’ Contributions

ZA contributed in conception, design, statistical analysis and drafting of the manuscript. AK and EA contributed in data collection and manuscript drafting. Z.A. supervised the study.

Funding Information

The current study was founded by a grant from the Vice-chancellor for Research, AUMS, and Iran.

Compliance with Ethical Standards

This investigation was done according to the principals of the Declaration of Helsinki and the study protocol was approved by the ethics committee of AUMS. All patients were informed about the aims and protocol of the study. Written informed consent was obtained from all subjects prior to the intervention.

Conflicts of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Salzberg SP, Adams DH, Filsoufi F (2005) Coronary artery surgery: conventional coronary artery bypass grafting versus off-pump coronary artery bypass grafting. Curr Opin Cardiol 20:509–516CrossRefGoogle Scholar
  2. 2.
    Murphy GJ, Angelini GD (2004) Side effects of cardiopulmonary bypass: what is the reality? J Card Surg 19:481–488CrossRefGoogle Scholar
  3. 3.
    Charlesworth DC, Likosky DS, Marrin CA et al (2003) Development and validation of a prediction model for strokes after coronary artery bypass grafting. Ann Thorac Surg 76:436–443CrossRefGoogle Scholar
  4. 4.
    McDonald C, Fraser J, Shekar K, Clarke A, Coombes J, Barnett A, Pearse B, Fung L (2016) Low preoperative selenium is associated with post-operative atrial fibrillation in patients having intermediate-risk coronary artery surgery. Eur J Clin Nutr 70:1138–1143CrossRefGoogle Scholar
  5. 5.
    Koszta G, Kacska Z, Szatmari K, Szerafin T, Fulesdi B (2012) Lower whole blood selenium level is associated with higher operative risk and mortality following cardiac surgery. J Anesth 26:812–821CrossRefGoogle Scholar
  6. 6.
    Stoppe C, Schalte G, Rossaint R et al (2011) The intraoperative decrease of selenium is associated with the postoperative development of multiorgan dysfunction in cardiac surgical patients. Crit Care Med 39:1879–1885CrossRefGoogle Scholar
  7. 7.
    Klotz LO, Kroncke KD, Buchczyk DP, Sies H (2003) Role of copper, zinc, selenium and tellurium in the cellular defense against oxidative and nitrosative stress. J Nutr 133:1448s–1451sCrossRefGoogle Scholar
  8. 8.
    Benstoem C, Goetzenich A, Kraemer S, Borosch S, Manzanares W, Hardy G, Stoppe C (2015) Selenium and its supplementation in cardiovascular disease--what do we know? Nutrients 7:3094–3118CrossRefGoogle Scholar
  9. 9.
    Ali-Hassan-Sayegh S, Mirhosseini SJ, Rezaeisadrabadi M, Dehghan HR, Sedaghat-Hamedani F, Kayvanpour E, Popov AF, Liakopoulos OJ (2014) Antioxidant supplementations for prevention of atrial fibrillation after cardiac surgery: an updated comprehensive systematic review and meta-analysis of 23 randomized controlled trials. Interact Cardiovasc Thorac Surg 18:646–654CrossRefGoogle Scholar
  10. 10.
    Bahmani F, Kia M, Soleimani A, Asemi Z, Esmaillzadeh A (2016) Effect of selenium supplementation on glycemic control and lipid profiles in patients with diabetic nephropathy. Biol Trace Elem Res 172:282–289CrossRefGoogle Scholar
  11. 11.
    Ju W, Li X, Li Z, Wu GR, Fu XF, Yang XM, Zhang XQ, Gao XB (2017) The effect of selenium supplementation on coronary heart disease: a systematic review and meta-analysis of randomized controlled trials. J Trace Elem Med Biol 44:8–16CrossRefGoogle Scholar
  12. 12.
    Akbarzadeh M, Eftekhari MH, Shafa M, Alipour S, Hassanzadeh J (2016) Effects of a new metabolic conditioning supplement on perioperative metabolic stress and clinical outcomes: a randomized, placebo-controlled trial. Iran Red Crescent Med J 18:e26207. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Jablonska E, Reszka E, Gromadzinska J et al (2016, 2016) The effect of selenium supplementation on glucose homeostasis and the expression of genes related to glucose metabolism. Nutrients 8(12)Google Scholar
  14. 14.
    Dhingra S, Bansal MP (2006) Modulation of hypercholesterolemia-induced alterations in apolipoprotein B and HMG-CoA reductase expression by selenium supplementation. Chem Biol Interact 161:49–56CrossRefGoogle Scholar
  15. 15.
    Luepker RV, Apple FS, Christenson RH et al (2003) Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute. Circulation 108:2543–2549CrossRefGoogle Scholar
  16. 16.
    Pisprasert V, Ingram KH, Lopez-Davila MF, Munoz AJ, Garvey WT (2013) Limitations in the use of indices using glucose and insulin levels to predict insulin sensitivity: impact of race and gender and superiority of the indices derived from oral glucose tolerance test in African Americans. Diabetes Care 36:845–853CrossRefGoogle Scholar
  17. 17.
    Tatsch E, Bochi GV, Pereira Rda S et al (2011) A simple and inexpensive automated technique for measurement of serum nitrite/nitrate. Clin Biochem 44:348–350CrossRefGoogle Scholar
  18. 18.
    Benzie IF, Strain JJ (1996) The ferric reducing ability of plasma (FRAP) as a measure of “antioxidant power”: the FRAP assay. Anal Biochem 239:70–76CrossRefGoogle Scholar
  19. 19.
    Beutler E, Gelbart T (1985) Plasma glutathione in health and in patients with malignant disease. J Lab Clin Med 105:581–584PubMedGoogle Scholar
  20. 20.
    Janero DR (1990) Malondialdehyde and thiobarbituric acid-reactivity as diagnostic indices of lipid peroxidation and peroxidative tissue injury. Free Radic Biol Med 9:515–540CrossRefGoogle Scholar
  21. 21.
    Bornfeldt KE, Tabas I (2011) Insulin resistance, hyperglycemia, and atherosclerosis. Cell Metab 14:575–585CrossRefGoogle Scholar
  22. 22.
    Lahoz C, Mostaza JM, Tranche S, Martin-Jadraque R, Mantilla MT, López-Rodriguez I, Monteiro B, Sanchez-Zamorano MA, Taboada M (2012) Atherogenic dyslipidemia in patients with established coronary artery disease. Nutr Metab Cardiovasc Dis 22:103–108CrossRefGoogle Scholar
  23. 23.
    Hansson GK (2005) Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 352:1685–1695CrossRefGoogle Scholar
  24. 24.
    Wang Y, Lin M, Gao X, Pedram P, du J, Vikram C, Gulliver W, Zhang H, Sun G (2017) High dietary selenium intake is associated with less insulin resistance in the Newfoundland population. PLoS One 12:e0174149. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Raygan F, Behnejad M, Ostadmohammadi V, Bahmani F, Mansournia MA, Karamali F, Asemi Z (2018) Selenium supplementation lowers insulin resistance and markers of cardio-metabolic risk in patients with congestive heart failure: a randomised, double-blind, placebo-controlled trial. Br J Nutr 120:33–40CrossRefGoogle Scholar
  26. 26.
    Tabrizi R, Akbari M, Moosazadeh M, Lankarani KB, Heydari ST, Kolahdooz F, Mohammadi AA, Shabani A, Badehnoosh B, Jamilian M, Assarian A, Asemi Z (2017) The effects of selenium supplementation on glucose metabolism and lipid profiles among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials. Horm Metab Res 49:826–830CrossRefGoogle Scholar
  27. 27.
    Sato H, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T (2010) The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. J Clin Endocrinol Metab 95:4338–4344CrossRefGoogle Scholar
  28. 28.
    Steinbrenner H (2013) Interference of selenium and selenoproteins with the insulin-regulated carbohydrate and lipid metabolism. Free Radic Biol Med 65:1538–1547CrossRefGoogle Scholar
  29. 29.
    Donma MM, Donma O (2016) Promising link between selenium and peroxisome proliferator activated receptor gamma in the treatment protocols of obesity as well as depression. Med Hypotheses 89:79–83CrossRefGoogle Scholar
  30. 30.
    Shargorodsky M, Debby O, Matas Z, Zimlichman R (2010) Effect of long-term treatment with antioxidants (vitamin C, vitamin E, coenzyme Q10 and selenium) on arterial compliance, humoral factors and inflammatory markers in patients with multiple cardiovascular risk factors. Nutr Metab (Lond) 7:55. CrossRefGoogle Scholar
  31. 31.
    Rayman MP, Stranges S, Griffin BA, Pastor-Barriuso R, Guallar E (2011) Effect of supplementation with high-selenium yeast on plasma lipids: a randomized trial. Ann Intern Med 154:656–665CrossRefGoogle Scholar
  32. 32.
    Omrani H, Golmohamadi S, Pasdar Y, Jasemi K, Almasi A (2016) Effect of selenium supplementation on lipid profile in hemodialysis patients. J Renal Inj Prev 5:179–182CrossRefGoogle Scholar
  33. 33.
    Luscher TF, von Eckardstein A, Simic B (2012) Therapeutic targets to raise HDL in patients at risk or with coronary artery disease. Curr Vasc Pharmacol 10:720–724CrossRefGoogle Scholar
  34. 34.
    Salehi M, Sohrabi Z, Ekramzadeh M, Fallahzadeh MK, Ayatollahi M, Geramizadeh B, Hassanzadeh J, Sagheb MM (2013) Selenium supplementation improves the nutritional status of hemodialysis patients: a randomized, double-blind, placebo-controlled trial. Nephrol Dial Transplant 28:716–723CrossRefGoogle Scholar
  35. 35.
    Yurekli VA, Naziroglu M (2013) Selenium and topiramate attenuates blood oxidative toxicity in patients with epilepsy: a clinical pilot study. Biol Trace Elem Res 152:180–186CrossRefGoogle Scholar
  36. 36.
    Bahmani F, Kia M, Soleimani A, Mohammadi AA, Asemi Z (2016) The effects of selenium supplementation on biomarkers of inflammation and oxidative stress in patients with diabetic nephropathy: a randomised, double-blind, placebo-controlled trial. Br J Nutr 116:1222–1228CrossRefGoogle Scholar
  37. 37.
    Siti HN, Kamisah Y, Kamsiah J (2015) The role of oxidative stress, antioxidants and vascular inflammation in cardiovascular disease (a review). Vasc Pharmacol 71:40–56CrossRefGoogle Scholar
  38. 38.
    Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS (2015) Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 154:13–20CrossRefGoogle Scholar
  39. 39.
    Gaudino M, Antoniades C, Benedetto U, Deb S, di Franco A, di Giammarco G, Fremes S, Glineur D, Grau J, He GW, Marinelli D, Ohmes LB, Patrono C, Puskas J, Tranbaugh R, Girardi LN, Taggart DP, Ruel M, Bakaeen FG (2017) Mechanisms, consequences, and prevention of coronary graft failure. Circulation 136:1749–1764CrossRefGoogle Scholar
  40. 40.
    Damy T, Kirsch M, Khouzami L, Caramelle P, le Corvoisier P, Roudot-Thoraval F, Dubois-Randé JL, Hittinger L, Pavoine C, Pecker F (2009) Glutathione deficiency in cardiac patients is related to the functional status and structural cardiac abnormalities. PLoS One 4:e4871. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Dernellis J, Panaretou M (2006) Effects of C-reactive protein and the third and fourth components of complement (C3 and C4) on incidence of atrial fibrillation. Am J Cardiol 97:245–248CrossRefGoogle Scholar
  42. 42.
    Forceville X (2006) Seleno-enzymes and seleno-compounds: the two faces of selenium. Crit Care 10:180CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology, Faculty of MedicineArak University of Medical SciencesArakIran
  2. 2.Research Center for Biochemistry and Nutrition in Metabolic DiseasesKashan University of Medical SciencesKashanIslamic Republic of Iran

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