Atherosclerosis Specialty Laboratory, James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, Providence Heart+Lung Institute, Department of Pathology and Laboratory Medicine, University of British Columbia-St. Paul's Hospital, Vancouver, British Columbia, Canada.
J Am Coll Cardiol. 2010 Mar 16;55(11):1102-9. doi: 10.1016/j.jacc.2009.11.050.
We evaluated the relative and combined value of oxidative stress biomarkers for predicting cardiovascular mortality in patients undergoing selective coronary angiography.
Oxidative stress participates in all stages of cardiovascular disease, from lipoprotein modification to plaque rupture, and biomarkers of oxidative stress predict development of coronary artery disease (CAD). Oxidative stress biomarkers merit investigation for the value they may offer for long-term cardiovascular risk prediction.
Myeloperoxidase (MPO), nitrotyrosine, oxidized low-density lipoprotein, and antioxidant capacity were measured in a prospective cohort of 885 selective coronary angiography patients followed up for >13 years for cardiovascular mortality.
MPO independently predicted CAD, and top tertile MPO levels predicted a 2.4-fold risk of cardiovascular mortality (95% confidence interval [CI]: 1.47 to 2.98), compared with patients with lowest tertile MPO levels. MPO also improved risk model discrimination and patient risk category classification. Elevations in multiple oxidative stress biomarkers predicted increased mortality risk; however, the strongest risk prediction was achieved by assessing MPO and C-reactive protein (CRP) together. Patients with either MPO or CRP elevated had 5.3-fold higher cardiovascular mortality risk (95% CI: 1.86 to 14.9), and patients with high levels of both MPO and CRP had a 4.3-fold risk compared with patients with only elevated marker (95% CI: 2.26 to 8.31). These results remained significant with adjustment for cardiovascular risk factors and baseline disease burden.
MPO accurately predicted cardiovascular mortality risk in coronary angiography patients. Considering MPO and CRP together may improve long-term risk assessment and CAD patient outcomes.
我们评估了氧化应激生物标志物在预测选择性冠状动脉造影患者心血管死亡率方面的相对和综合价值。
氧化应激参与了心血管疾病的所有阶段，从脂蛋白修饰到斑块破裂，氧化应激的生物标志物可预测冠状动脉疾病（CAD）的发展。氧化应激生物标志物值得研究，因为它们可能为长期心血管风险预测提供价值。
我们在一个前瞻性队列中测量了 885 例选择性冠状动脉造影患者的髓过氧化物酶（MPO）、硝基酪氨酸、氧化型低密度脂蛋白和抗氧化能力，这些患者在随访超过 13 年后发生心血管死亡。
MPO 独立预测 CAD，与 MPO 水平最低的三分位患者相比，MPO 水平最高的三分位患者发生心血管死亡率的风险增加 2.4 倍（95%置信区间[CI]：1.47 至 2.98）。多种氧化应激生物标志物的升高预测死亡率风险增加；然而，通过评估 MPO 和 C 反应蛋白（CRP）的联合评估，可实现最强的风险预测。MPO 或 CRP 升高的患者心血管死亡率风险增加 5.3 倍（95%CI：1.86 至 14.9），而 MPO 和 CRP 水平均升高的患者风险比仅升高标志物的患者高 4.3 倍（95%CI：2.26 至 8.31）。在调整心血管危险因素和基线疾病负担后，这些结果仍然具有统计学意义。
MPO 可准确预测冠状动脉造影患者的心血管死亡率风险。综合考虑 MPO 和 CRP 可能会改善长期风险评估和 CAD 患者的预后。
