Oxidative Stress and DNA Damage Biomarkers in Heart Failure: A Systematic Review and Meta-Analysis

Background: Oxidative stress is a key driver of heart failure (HF) pathophysi-ology, promoting myocardial injury, inflammation, and remodeling. Alt-hough numerous biomarkers of oxidative stress and DNA damage have been investigated in HF, their clinical relevance remains uncertain. This systematic review and meta-analysis aimed to evaluate alterations in these biomarkers in HF patients compared to healthy controls. Methods: A comprehensive search of PubMed, MEDLINE, the Cochrane Li-brary, and Web of Science was conducted in accordance with PRISMA guide-lines. Studies reporting oxidative stress or DNA damage biomarkers in HF pa-tients versus controls were included. Random-effects models were used to calculate ratios of means (ROM) with 95% confidence intervals (CI). Hetero-geneity and publication bias were assessed using the I² statistic and Egger’s test. Results: Data from 2,188 HF patients and 1,073 controls were analyzed. HF patients had significantly higher levels of isoprostanes (ROM = 2.83, 95% CI: 1.97–4.05), 8-hydroxy-2′-deoxyguanosine (8-OHdG) (ROM = 2.24, 95% CI: 1.75–2.88), and malondialdehyde (MDA) (ROM = 1.87, 95% CI: 1.49–2.36). Te-lomere length was significantly shorter (ROM = 0.66, 95% CI: 0.53–0.81), indi-cating accelerated cellular aging. Considerable heterogeneity was observed across studies. Conclusion: This meta-analysis supports a robust association between oxida-tive stress, DNA damage, and HF, highlighting the potential role of these bi-omarkers in disease monitoring and prognosis.