• Oxidized LDL is atherogenic and directly involved in the initiation and progression of the
  atherosclerotic disease process.
• Oxidized LDL is a predictive biomarker for the sub-clinical development of atherosclerosis and subsequent events.
• Oxidized LDL is a more accurate biomarker for developing atherosclerosis than other more traditional laboratory tests for measuring blood lipid levels.
• Combining oxidized LDL data with data from other biomarkers gives a powerful tool for
  distinguishing CAD patients from healthy non-CAD controls.
  

Today it is widely believed that the development and progression of atherosclerosis is caused by a chronic inflammation in the vessel wall. Oxidized LDL is thought to play a key role in the inflammatory process and is found to be directly involved in the initiation and progression of atherosclerosis – from the early-stage conversion of the lipid-laden foam cells, to the late-stage development of plaque instability and rupture (Fig. 1).

Mercodia oxidized LDL ELISAs are based on the mouse monoclonal antibody 4E6, developed by professor Holvoet and professor Collen at the University of Louven, Louven, Belgium. Holvoet et al. (1998) were the first to demonstrate elevated levels of circulating oxidized LDL in untreated patients with stable coronary artery disease (CAD)
as well as in patients with acute coronary syndromes (fig. 2). These findings are important and suggest that this increase is independent of plaque instability.
Combining oxidized LDL data with data from other biomarkers gives an even more powerful tool for distinguishing between cardiovascular disease patients and healthy control subjects. In a study by Johnston et al. (2006) oxidized LDL was used in combination with HDL-cholesterol. Johnston et al. found the ratio of oxidized LDL to
HDL-cholesterol to be a more potent marker in discriminating CAD patients from healthy controls than traditionally used measurements of lipids and lipoproteins as well as Lp-PLA2 (Fig 3.).

Holvoet et al. (1998) Oxidized LDL and Malondialdehyde-Modified LDL in Patients With Acute Coronary Syndromes and Stable Coronary Artery Disease. Circulation 98: 1487-1494
Johnston et al. (2006) Improved Identification of Patients with Coronary Artery Disease by the Use of New Lipid and Lipoprotein Biomarkers. Am J Cardiol 97: 640–645
Meisinger et al. (2005) Plasma Oxidized Low-Density Lipoprotein, a Strong Predictor for Acute Coronary Heart Disease Events in Apparently Healthy, Middle-Aged Men From the General
Population. Circulation 112: 651-657
Sigurdardottir et al. (2002) Circulating oxidized low-density lipoprotein (LDL) is associated with risk factors of the metabolic syndrome and LDL size in clinically healthy 58-year-old men
(AIR study). J Intern Med 252: 440-447
Wallenfeldt et al. (2004) Oxidized low-density lipoprotein in plasma is a prognostic marker of subclinical atherosclerosis development in clinically healthy men. J Intern Med 256: 413-
420

Figure 1. Involvement of oxidized LDL in the initiation and progression of the atherosclerotic disease process.

Figure 2. Compared to controls, oxidized LDL levels are elevated in patients with stable angina, unstable angina and acute myocardial infarction (AMI). Published data by Holvoet et al. (1998).

Figure 3. Receiver-operating characteristic curves for (A) traditional lipids and
lipoproteins and (B) emerging lipid and lipoprotein biomarkers HDL-C=HDL
cholesterol; LDL-C=LDL cholesterol; OxLDL=oxidized LDL; TC=total cholesterol;
TRIG=triglyceride. Published data by Johnston et al. (2006).

Figure 4. The Triple-Marker Test in various stages of CAD. Values, obtained
by multiplying the ratio of oxidized LDL / HDL - cholesterol with CRP, rise progressively from non-CAD (0.2), to stable angina (1.8), to unstable angina (4.4), and to acute myocardial infarction (AMI) (7.5).

Figure 5. Relative potency of biomarkers to discriminate between CAD and
non-CAD patients.

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