Elsevier

Clinical Biochemistry

Volume 41, Issues 14–15, October 2008, Pages 1162-1167
Clinical Biochemistry

An oxidative stress score as a combined measure of the pro-oxidant and anti-oxidant counterparts in patients with coronary artery disease

https://doi.org/10.1016/j.clinbiochem.2008.07.005Get rights and content

Abstract

Oxidative stress plays a key role in the pathogenesis and development of atherosclerosis.

Aim

To evaluate the relationship between a novel oxidative stress index (reflecting both oxidative and anti-oxidant counterparts) with traditional cardiovascular risk factors and C-reactive protein (CRP) in coronary artery disease (CAD).

Methods

100 angiographically proven CAD and 70 control subjects (mean age: 65 ± 10 years, 110 males), underwent a global cardiovascular risk assessment and serum CRP and oxidative stress estimation. The Oxidative-INDEX was calculated after automated evaluation of serum hydroperoxides and total anti-oxidant capacity (D-ROM and OXY-adsorbent Test, Diacron, Italy) subtracting the OXY standardized variable from the ROM standardized variable.

Results

The Oxidative-INDEX was higher in CAD with respect to control subjects (p < 0.001). A stepwise elevation in the Oxidative-INDEX levels was found depending on the number of affected vessels (p < 0.001). Oxidative stress was elevated according to the presence of diabetes (p < 0.001), smoking habit (p < 0.01), and hypercholesterolemia (p < 0.05). Oxidative-INDEX significantly correlated with aging (p  0.05) and CRP (p < 0.001). The Oxidative-INDEX increased with the number of cardiovascular risk factors (p < 0.001).

After adjustment for traditional CV risk factors, the multivariate logistic regression analysis indicated the Oxidative-INDEX concentration as an independent factor for CAD (odds ratio = 1.4, confidence intervals = 1.1–1.9, p < 0.05).

Conclusion

Oxidative stress represents a shared molecular pathway in atherosclerotic-related conditions, and its estimation by the automated Oxidative-INDEX could represent a valuable tool and a promising target in the prevention, diagnosis and treatment of CAD in the clinical setting.

Introduction

Inflammation and oxidative stress represent interrelated processes which play a key role in the pathogenesis and development of atherosclerosis [1]. However, at the moment, most available methods for evaluating oxidative stress in vivo are inappropriate for large-scale use, which limits their application in clinical practise [2], [3], [4]. Moreover, the choice of biomarkers indicating oxidative stress or anti-oxidant state in specific patient categories is still largely controversial [2], [3], [4].

Recently, we have described an improved protocol for the automated estimation of the derivatives of reactive oxygen metabolites and the total anti-oxidant status by using an automated clinical chemistry analyser [5], [6], [7]. This procedure optimizes standardization and allows high-throughput by reducing variability sources, with high reproducibility, consistent accuracy, and much smaller amounts of sera and reagents than required by conventional manual assays. Furthermore, we've also proposed the calculation of a simple oxidative stress index (Oxidative-INDEX), which reflects both the pro-oxidative and anti-oxidant counterparts, thus potentially more complete and powerful [7].

The present study aimed to apply this procedure to verify the relationship between the Oxidative-INDEX with traditional cardiovascular risk factors and C-reactive protein (CRP) levels in coronary artery disease (CAD).

Section snippets

Subjects

A total of 170 subjects (mean age: 65 ± 10 years, 110 males) were enrolled in the study, according to previously described criteria [8], [9], and included 100 angiographically proven CAD patients and a group of 70 subjects as controls, who had no history or signs of cardiovascular disease, and who were screened for the presence of cardiovascular risk factors. All CAD patients, who had been recruited from the Clinical Cardiology Department of our Institute, underwent coronary angiography and

Results

The clinical characteristics of the study population according to the presence of CAD are presented in Table 1. As expected, patients with CAD were more likely to present risk factors such as smoking habit, dyslipidemia, diabetes and increased CRP levels. Likewise, CAD patients presented higher levels of hydroperoxides and lower total anti-oxidant capacity with respect to control subjects (422 ± 13 versus 328 ± 9 AU, p < 0.001 and 365 ± 12 versus 340 ± 8 μmol HClO/mL, respectively).

The distribution

Discussion

Although reactive oxygen species are normally produced by aerobic metabolism, the cellular redox status is normally maintained through the action of anti-oxidant systems [13]. However, disturbance of this balance may lead to a pro-oxidant situation when oxidative stress occurs [13]. In this status, reactive oxygen species may react with a variety of biological targets, including lipids, proteins, carbohydrates, nucleic acids, and induce indiscriminated damage to membranes, organelles, enzymes,

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