Myeloperoxidase, Subclinical Atherosclerosis, and Cardiovascular Disease Events

Nathan D. Wong, Heidi Gransar, Jagat Narula, Leslee Shaw, Johanna H. Moon, Romalisa Miranda-Peats, Alan Rozanski, Sean W. Hayes, Louise E.J. Thomson, John D. Friedman, Daniel S. Berman

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Objectives: We evaluated whether myeloperoxidase (MPO) predicts future cardiovascular disease (CVD) events in asymptomatic adults and whether subclinical atherosclerosis may affect this relation. Background: Myeloperoxidase is a leukocyte-derived enzyme-generating reactive oxidant species that has been shown to predict risk of CVD in selected populations. Methods: We studied 1,302 asymptomatic adults (mean age 59 years, 47% women) without known CVD who were followed for 3.8 years. We measured MPO by the use of immunoassay. Coronary artery calcium (CAC), a measure of subclinical atherosclerosis, was measured by computed tomography with the Agatston score categorized as none/minimal (0 to 9), mild (10 to 99), and moderate/significant (≥100). Cox regression, adjusted for age, sex, and other risk factors, examined the relation of CAC and/or MPO with incident CVD events. Results: Persons with MPO levels at or above compared with below the median (257 pM) were more likely (p < 0.05 to p < 0.001) to be women, have a higher body mass index, greater low-density lipoprotein cholesterol, greater systolic and diastolic blood pressure, and lower high-density lipoprotein cholesterol. Mean MPO levels increased according to CAC categories (p trend = 0.02). Incident CVD events were more likely in those at or above versus below the median MPO level (4.6% vs. 2.3%, p = 0.02), even after adjustment for age, sex, CAC, and risk factors (hazard ratio [HR]: 1.9, 95% confidence interval: 1.0 to 3.6, p = 0.04). Combining CAC and MPO categories, CVD incidence ranged from 0.6% in those with a CAC score of 0 to 9 to 7.1% (adjusted HR: 9.2, p < 0.001) in those with CAC scores of ≥100 and MPO below the median and 14.0% (adjusted HR: 19.5, p < 0.0001) in those with CAC scores of ≥100 and MPO at or above the median. Conclusions: Our study suggests persons with both increased levels of both MPO and CAC are at an increased risk of CVD events. Imaging of subclinical atherosclerosis combined with assessment of biomarkers of plaque vulnerability may help improve CVD risk stratification.

Original languageEnglish
Pages (from-to)1093-1099
Number of pages7
JournalJACC: Cardiovascular Imaging
Issue number9
StatePublished - Sep 2009
Externally publishedYes


  • biomarkers
  • cardiovascular disease
  • computed tomography
  • prevention
  • risk factors


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