A plasma oxidative stress global index in early stages of chronic venous insufficiency

BackgroundChronic venous insufficiency (CVI) represents a social and health care problem because it affects working age populations, particularly in jobs requiring orthostasis, has no effective pharmacologic treatment, and requires surgery. Oxidative stress is present in varicose veins, but whether this is reflected in the plasma is controversial. We aimed to quantify plasma oxidative stress biomarkers in the early stages of CVI and calculate a global index of oxidative stress representative of the disease.MethodsPlasma was obtained from blood samples of nine patients with CEAP C2 stage CVI and 10 healthy controls. Biomarkers related to antioxidant defense systems (total thiols, reduced glutathione, uric acid, total antioxidant capacity, catalase), oxidative damage (malondialdehyde-bound protein, protein carbonyls, advanced oxidation products, and 3-nitrotyrosine), and activity of enzymes producing key free radicals (xanthine oxidase and myeloperoxidase) were assessed.ResultsCompared with the controls, CVI patients exhibited decreased catalase activity and thiol levels and increased malondialdehyde-bound protein and protein carbonyls. These parameters were used to calculate the global index of oxidative stress in CVI, which was significantly different between groups.ConclusionsIt is possible to detect significant changes in plasma oxidative stress biomarkers in early stages of CVI and to calculate a global index representative of the oxidative status in an individual. This index, with the appropriate validation in a larger population, could be used for early detection or progression of CVI.

Clinical RelevanceThis report describes the calculation of a global index of oxidative status that allows detecting differences at early stages of chronic venous insufficiency (CVI). We propose that this index can be used as a diagnostic tool for early detection of CVI or its progression. Obviously, this requires further development and studies, including a larger number of individuals, which is a limitation of this study; for example, to include patients at C1 stages of CVI, who do not exhibit varicose veins, and to monitor them in a longitudinal study to establish if an initial elevation of oxidative stress can predict CVI progression. Although CVI is not a life-threatening condition, it is relatively common, particularly in some risk groups, and surgery is the treatment of choice. Therefore, an early detection in groups at risk and the development of preventive treatments with antioxidant-related pharmacologic therapy could reduce the number of surgical interventions with all the inconveniences and cost implicated. Another possible application of this tool could be to predict the progression of the disease; for example, screening patients undergoing surgery and assessing the possible relationship between initial oxidative status and the development of recurrence.