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Background  Despite pathophysiological relevance and promising experimental data, the usefulness of biomarkers of oxidative stress for cardiac risk prediction is unclear. The aim of our study was to investigate the prognostic value of 6 biomarkers exploring different pathways of oxidative stress for predicting adverse cardiovascular outcomes in patients with type 2 diabetes mellitus beyond established risk factors.    Methods and Results  The  SURDIAGENE  (Survie, Diabete de type 2 et Genetique) prospective cohort study consecutively recruited 1468 patients with type 2 diabetes mellitus. Assays were performed at baseline, and incident cases of major adverse cardiovascular events ( MACE )—first occurrence of cardiovascular death, nonfatal myocardial infarction, or stroke—were recorded during a median of 64 months. Advanced oxidation protein products, oxidative hemolysis inhibition assay, ischemia‐modified albumin, and total reductive capacity of plasma were not associated with the risk of  MACE  in univariate analyses. Fluorescent advanced glycation end products and carbonyls were associated with  MACE  (hazard ratio=1.38 per  SD , 95% confidence interval 1.24‐1.54,  P <0.001 and hazard ratio=1.15 per  SD , 95% confidence interval 1.04‐1.27,  P =0.006, respectively) in univariate analysis, but when added to a multivariate predictive model including traditional risk factors for  MACE , these markers did not significantly improve c‐statistics or integrated discrimination index of the model.    Conclusions  These plasma concentrations of 6 markers, which cover a broad spectrum of oxidative processes, were not significantly associated with  MACE  occurrence and were not able to improve  MACE  risk discrimination and classification beyond classical risk factors in type 2 diabetes mellitus patients.

journal of the american heart association

Circulating Concentrations of Redox Biomarkers Do Not Improve the Prediction of Adverse Cardiovascular Events in Patients With Type 2 Diabetes Mellitus