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American Journal of Epidemiology Advance Access originally published online on May 22, 2009
American Journal of Epidemiology 2009 170(2):135-147; doi:10.1093/aje/kwp112
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Antioxidant Enzyme Activity and Coronary Heart Disease: Meta-analyses of Observational Studies

Gemma Flores-Mateo, Paloma Carrillo-Santisteve, Roberto Elosua, Eliseo Guallar, Jaume Marrugat, Joachim Bleys and María-Isabel Covas

Correspondence to Dr. María-Isabel Covas, Cardiovascular Risk and Nutrition Research Group, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar), Parc de Recerca Biomèdica de Barcelona (PRBB), Carrer Dr Aiguader, 88; 08003, Barcelona, Spain (e-mail: mcovas{at}imim.es).

Received for publication December 4, 2008. Accepted for publication April 9, 2009.

Controversial data exist concerning the relation between the activities of scavenger antioxidant enzymes and coronary heart disease (CHD) risk. The authors report updated meta-analyses of studies assessing the activities of 3 antioxidant enzymes—glutathione peroxidase, superoxide dismutase, and catalase—and CHD risk. Computer-based and manual searches of the relevant literature from January 1966 to January 2008 were performed. Studies assessing glutathione peroxidase, superoxide dismutase, and catalase activities in cells or biologic fluids and clinical CHD outcomes were selected. Pooled odds ratios for CHD were calculated by using an inverse-variance-weighted random-effects model. Forty-two case-control studies and 3 prospective studies were included. The pooled odds ratios for CHD associated with a 1-standard-deviation increase in glutathione peroxidase, superoxide dismutase, and catalase activity levels were 0.51 (95% confidence interval: 0.35, 0.75), 0.48 (95% confidence interval: 0.32, 0.72), and 0.32 (95% confidence interval: 0.16, 0.61), respectively, with substantial between-study heterogeneity (I2 > 90% for the 3 enzymes). These findings were remarkably robust in the sensitivity analysis. The authors’ meta-analyses support an inverse association between circulating levels of superoxide dismutase, glutathione peroxidase, and catalase activities with CHD and emphasize the need for additional high-quality prospective studies.

cardiovascular diseases; catalase; coronary disease; glutathione peroxidase; meta-analysis; superoxide dismutase

Abbreviations: CHD, coronary heart disease; GSH-Px, glutathione peroxidase; SOD, superoxide dismutase


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