title: Minimal and best linear combination of oxidative stress and antioxidant biomarkers to discriminate cardiovascular disease.
abstract: OBJECTIVE
  Free radicals have been implicated in the atherosclerotic process of coronary heart disease (CHD). Well-developed laboratory methods may make available a large number of biomarkers of individual oxidative stress and antioxidant status. Such markers are able to quantify different phases of the oxidative stress and antioxidant status of an individual. However, limited knowledge is available on how to combine these biomarkers to best discriminate between individuals with and without CHD.
  
  
  RESULTS
  We evaluated combined discrimination properties of six biomarkers of oxidative stress and antioxidant status, as indicators of CHD, in a cross-sectional random sample of 968 white men and women from Buffalo, New York. Individuals with CHD had significantly higher levels of thiobarbuturic acid reacting substances (TBARS) and uric acid, and significantly lower levels of high-density lipoproteins (HDL) after adjusting for age and gender, when compared to healthy subjects. There were no significant differences in erythrocyte glutathione (GSH), trolox equivalent antioxidant capacity (TEAC), and glutathione peroxidase (GSHPx) levels. TBARS were found to be the best discriminating of the biomarkers when it was individually evaluated. TBARS discriminate 76.2% (95% C.I. 0.66-0.82) of the CHD cases from healthy controls. When combining TBARS, GSH, TEAC, HDL, uric acid and GSHPx, they discriminate 81.5% (95% C.I.: 0.67-0.90) of the area under the curve.
  
  
  CONCLUSIONS
  These preliminary findings suggest that the combination of multiple markers of oxidative stress does not greatly improve ability to differentiate between individuals with and without CHD compared to the use of TBARS alone.
authors.affiliation: Department of Social and Preventive Medicine, University at Buffalo, Buffalo, NY 14214, USA. schistee@mail.nih.gov
authors.forename: E F
authors.initials: EF
authors.lastname: Schisterman
authors.forename: D
authors.initials: D
authors.lastname: Faraggi
authors.forename: R
authors.initials: R
authors.lastname: Browne
authors.forename: J
authors.initials: J
authors.lastname: Freudenheim
authors.forename: J
authors.initials: J
authors.lastname: Dorn
authors.forename: P
authors.initials: P
authors.lastname: Muti
authors.forename: D
authors.initials: D
authors.lastname: Armstrong
authors.forename: B
authors.initials: B
authors.lastname: Reiser
authors.forename: M
authors.initials: M
authors.lastname: Trevisan
mesh_terms: D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000032:analysis; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis; D003430:Cross-Sectional Studies; D005260:Female; D005609:Free Radicals; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D009518:New York; D018384:Oxidative Stress / Q000502:physiology*; D012372:ROC Curve; D017392:Thiobarbituric Acid Reactive Substances / Q000032:analysis*; D014527:Uric Acid / Q000097:blood
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D005609:Free Radicals; D008075:Lipoproteins, HDL; D017392:Thiobarbituric Acid Reactive Substances; D014527:Uric Acid