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) pathophysiology, promoting myocardial injury, inflammation, and remodeling. Although 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 Library, and Web of Science was conducted in accordance with PRISMA guidelines. Studies reporting oxidative stress or DNA damage biomarkers in HF patients versus controls were included. Random-effects models were used to calculate ratios of means (ROM) with 95% confidence intervals (CI). Heterogeneity and publication bias were assessed using the I² statistic and Begg’s test. Results: Data from 3015 HF patients and 2704 controls were analyzed. HF patients had significantly higher levels of 8-hydroxy-2′-deoxyguanosine (8-OHdG) (ROM = 2.24, 95% CI: 1.75–2.88), malondialdehyde (MDA) (ROM = 1.87, 95% CI: 1.49–2.36) and isoprostanes (ROM = 2.83, 95% CI: 1.97–4.05). Telomere length was significantly shorter (ROM = 0.66, 95% CI: 0.53–0.81), indicating accelerated cellular aging. Considerable heterogeneity was observed across studies. Conclusion: This meta-analysis supports a robust association between oxidative stress, DNA damage, and HF, highlighting the potential role of these biomarkers in disease monitoring and prognosis.