Myeloperoxidase levels predicts angiographic severity of coronary artery disease in patients with chronic stable angina


1 Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran

3 Environment Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


Background : Myeloperoxidase (MPO) has an important role in the both processes of inflammation and oxidative stress. It plays proatherogenic role via low-density lipoprotein oxidation, functional inactivation of the high-density lipoprotein and endothelial dysfunction, and seems to be involved in the atherogenesis of coronary arteries. This study designed to evaluate the association between the plasma MPO levels and angiographic severity of coronary artery disease (CAD) in patients with the stable CAD.
Materials and Methods: Sixty-eight patients who had documented CAD with angiography and 66 subjects who had normal angiography were selected as case and the control groups for this study, respectively. Gensini scoring system was used for evaluation of severity of coronary artery stenosis. Plasma MPO and C-reactiveprotein (CRP) levels of both case and control groups were determined.
Results: Plasma MPO levels and CRP levels were significantly higher in CAD patients (P < 0.001), and plasma levels of MPO and CRP were correlated with Genssini scores.
Conclusions: Our findings indicated that the plasma MPO levels increase in patients with stable CAD and hence that, it can be used as adiagnostic factor to predict the coronary artery atherosclerosis severity in stable CAD patients; However, it needs further widespread investigations to achieve an accurate cut point.


1. Ross R. Atherosclerosis as an inflammatory disease. New Engl J Med 1999; 340:115-26.  Back to cited text no. 1
2. Nicholls SJ, Hazen sl. Myeloperoxidase and cardiovascular disease. Arterioscl Throm Vas Biol 2005;25:1102-11.  Back to cited text no. 2
3. Ikitimur B, Karadag B. Role of myeloperoxidase in cardiology. Future Cardiol 2010;6:693-702.  Back to cited text no. 3
4. Lau D, Baldus S. Myeloperoxidase and its contributory role in inflammatory vascular disease. Pharmacol Therapeut 2006;111:16-26.  Back to cited text no. 4
5. Sugiyama S, Okada Y, Sukhova GK, Virmani R, Heinecke JW, Libby P. Macrophage myeloperoxidase regulation by granulocyte macrophage colony-stimulating factor in human atherosclerosis and implications in acute coronary syndromes. Am J Clin Pathol 2001;158:879-91.  Back to cited text no. 5
6. Eiserich JP, Baldus S, Brennan ML, Ma W, Zhang C, Tousson A, et al.Myeloperoxidase a leukocyte-derived vascular No oxidase. Science 2002; 296:2391.  Back to cited text no. 6
7. Hazen SL. Myeloperoxidase and plaque vulnerability. Arterioscl Throm Vas Biol 2004;24:1143-6.  Back to cited text no. 7
8. Podrez EA, Schmitt D, Hoff HF, Hazen SL. Myeloperoxidase-generated reactive nitrogen species convert LDL into an atherogenic form in vitro. J Clin Invest 1999;103:1547-60.  Back to cited text no. 8
9. Vita JA, Brennan ML, Gokce N, Mann SA, Goormastic M, Shishehbor MH, et al. Serum Myeloperoxidase Levels Independently Predict Endothelial Dysfunction in Humans. Circulation 2004;110:134-9.  Back to cited text no. 9
10. Zheng L, Nukuna B, Brennan ML, Sun M, Goormastic M, Settle M, et al. Apolipoprotein AI is a selective target for myeloperoxidase-catalyzed oxidation and functional impairment in subjects with cardiovascular disease J Clin Invest 2004;114:529-41.  Back to cited text no. 10
11. Brennan ML, Penn MS, VanLente F, Nambi V, Shishehbor MH, Aviles RJ, et al. Prognostic value of myeloperoxidase in patients with chest pain New Engl J Med 2003;349:1595-604.  Back to cited text no. 11
12. Zhang R, Brennan ML, Fu X, Aviles RJ, Pearce GL, Penn MS, et al.Association between myeloperoxidase levels and risk of coronary artery disease. JAMA 2001;286:2136-42.  Back to cited text no. 12
13. Meuwese MC, Stroes ES, Hazen SL, vanMiert JN, Kuivenhoven JA, Schaub RG, et al. Serum Myeloperoxidase Levels Are Associated With the Future Risk of Coronary Artery Disease in Apparently Healthy Individuals: The EPIC-Norfolk Prospective Population Study. J Am Coll Cardiol 2007; 50:159-65.  Back to cited text no. 13
14. Podrez EA, Abu-Soud HM, Hazen SL. Myeloperoxidase-generated oxidants and atherosclerosis. Free Radic Biol Med 2000;28:1717-25.  Back to cited text no. 14
15. Daugherty A, Dunn JL, Rateri DL, Heinecke JW. Myeloperoxidase, a catalyst for lipoprotein oxidation, is expressed in human atherosclerotic lesions. J Clin Invest 1994;94:437.  Back to cited text no. 15
16. Hazen SL, Heinecke JW. 3-Chlorotyrosine, a specific marker of myeloperoxidase-catalyzed oxidation, is markedly elevated in low density lipoprotein isolated from human atherosclerotic intima. J Clin Invest 1997; 99:2075.  Back to cited text no. 16
17. Hazen SL, Hsu FF, Heinecke JW. p-Hydroxyphenylacetaldehyde Is the Major Product of L-Tyrosine Oxidation by Activated Human Phagocytes A chloride-dependent mechanism for the conversion of free amino acids into reactive aldehydes by myeloperoxidase. J Biol Chem 1996;271:1861-7.  Back to cited text no. 17
18. Shao B, Pennathur S, Heinecke JW. Myeloperoxidase targets apolipoprotein AI, the major high density lipoprotein protein, for Site-Specific Oxidation in Human Atherosclerotic Lesions. J Biol Chem 2012;287:6375-86.  Back to cited text no. 18
19. Soud HM, Hazen SL. Nitric oxide is a physiological substrate for mammalian peroxidases. J Biol Chem 2000;275:37524-32.  Back to cited text no. 19
20. Soud HM, Khassawneh MY, Sohn JT, Murray P, Haxhiu MA, Hazen SL. Peroxidases inhibit nitric oxide (NO) dependent bronchodilation: development of a model describing NO-peroxidase interactions. Biochemistry 2001;40:11866-75.  Back to cited text no. 20
21. Wainstein RV, Wainstein MV, Ribeiro JP, Dornelles LV, Tozzati P, Ashton-Prolla P, et al. Association between myeloperoxidase polymorphisms and its plasma levels with severity of coronary artery disease. Clin Biochem 2010;43:57-62.  Back to cited text no. 21
22. Düzgünçinar O, Yavuz B, Hazirolan T, Deniz A, Tokgözoðlu SL, Akata D, et al . Plasma myeloperoxidase is related to the severity of coronary artery disease. Acta Cardiol 2008;63:147-52.  Back to cited text no. 22
23. Baldus S, Rudolph V, Roiss M, Ito WD, Rudolph TK, Eiserich JP, et al. Heparins increase endothelial nitric oxide bioavailability by liberating vessel-immobilized myeloperoxidase. Circulation 2006;113:1871-8.  Back to cited text no. 23
24. Stefanescu A, Braun S, Ndrepepa G, Koppara T, Pavaci H, Mehilli J, et al.Prognostic value of plasma myeloperoxidase concentration in patients with stable coronary artery disease. Am Heart J 2008;155: 356-60.  Back to cited text no. 24
25. Kubala L, Lu G, Baldus S, Berglund L, Eiserich JP. Plasma levels of myeloperoxidase are not elevated in patients with stable coronary artery disease. Clin Chim Acta 2008;394:59-62.  Back to cited text no. 25
26. Lee CH, Tai BC, Lim GH, Chan MY, Low AF, Tan KC, et al. Correlation between high density lipoprotein-cholesterol and remodeling index in patients with coronary artery disease: IDEAS (IVUS diagnostic evaluation of atherosclerosis in Singapore)-HDL study. Int J Cardiovas Imag (formerly Cardiac Imaging): 2012;28:33-41.  Back to cited text no. 26
27. Maron DJ. The epidemiology of low levels of high-density lipoprotein cholesterol in patients with and without coronary artery disease. Am J cardiol 2000;86:11L-14L.  Back to cited text no. 27
28. Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, et al. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 1989;79:8-15.  Back to cited text no. 28
29. Naito HK, Greenstreet RL, David JA, Sheldon WL, Shirey EK, Lewis RC, et al. HDL-cholesterol concentration and severity of coronary atherosclerosis determined by cine-angiography. Artery 1980;8:101-12.  Back to cited text no. 29
30. Van Lenten BJ, Hama SY, deBeer FC, Stafforini DM, McIntyre TM, Prescott SM, et al. Anti-inflammatory HDL becomes pro-inflammatory during the acute phase response. Loss of protective effect of HDL against LDL oxidation in aortic wall cell cocultures. J Clin Invest 1995;96:2758.  Back to cited text no. 30
31. VanLenten BJ, Wagner AC, Nayak DP, Hama S, Navab M, Fogelman AM. High-density lipoprotein loses its anti-inflammatory properties during acute influenza A infection. Circulation 2001;103:2283-8.  Back to cited text no. 31
32. Mehta NM, Bechard LJ, Leavitt K, Duggan C, et al. Inflammatory biomarkers, physical activity, waist circumference, and risk of future coronary heart disease in healthy men and women. Eur Heart J 2011;32:336-44.  Back to cited text no. 32
33. Karakas M, Koenig W, Zierer A, Herder C, Rottbauer W, Baumert J, et al.Myeloperoxidase is associated with incident coronary heart disease independently of traditional risk factors: results from the MONICA/KORA Augsburg study. J Intern Med 2012;271:43-50.  Back to cited text no. 33
34. Tang WH, Wu Y, Nicholls SJ, Hazen SL. Plasma myeloperoxidase predicts incident cardiovascular risks in stable patients undergoing medical management for coronary artery disease. Clin Biochem 2011;57:33-9.  Back to cited text no. 34
35. Heslop CL, Frohlich JJ, Hill JS. Myeloperoxidase and C-reactive protein have combined utility for long-term prediction of cardiovascular mortality after coronary angiography. J Am Coll Cardiol 2010;55:1102-9.  Back to cited text no. 35
36. Kutter D, Devaquet P, Vanderstocken G, Paulus JM, Marchal V, Gothot A. Consequences of total and subtotal myeloperoxidase deficiency: Risk or benefit? Acta Haematol 2000;104:10-5.  Back to cited text no. 36
37. Nikpoor B, Turecki G, Fournier C, Théroux P, Rouleau GA, A functional myeloperoxidase polymorphic variant is associated with coronary artery disease in French-Canadians. Am Heart J 2001;142:336-9.  Back to cited text no. 37
38. Mocatta TJ, Pilbrow AP, Cameron VA, Senthilmohan R, Frampton CM, Richards AM, et al. Plasma concentrations of myeloperoxidase predict mortality after myocardial infarction. J Am Coll Cardiol 2007;49:1993-2000.  Back to cited text no. 38
39. Morrow DA, Sabatine MS, Brennan ML, deLemos JA, Murphy SA, Ruff CT, et al. Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome: Myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICS-TIMI 18. Eur Heart J 2008;29:1096.  Back to cited text no. 39