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Cardiovascular Research 2000 47(3):409; doi:10.1016/S0008-6363(00)00156-5
© 2000 by European Society of Cardiology
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Copyright © 2000, European Society of Cardiology

Antioxidants and cardiovascular disease; panaceas or tonics for tired sheep?

Francesco Visiolia,*, John F. Keaney, Jr.b and Barry Halliwellc

aInstitute of Pharmacological Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy
bEvans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Meicine, Boston, MA and VA Boston Health Care System, Boston MA, USA
cDepartment of Biochemistry, National University of Singapore, Kent Ridge Crescent, Singapore 119260, Singapore

* Corresponding author

There is now a large body of population studies showing that diets high in fruits and vegetables, i.e. foods rich in antioxidant compounds, are associated with a lower incidence of cardiovascular disease [1]; moreover, many in vitro and some in vivo studies have suggested that oxidative modification of low density lipoprotein is involved in the onset of atherosclerosis and exacerbates its clinical manifestations [2]. Hence, the hypothesis was formulated that antioxidants may at least in part prevent atherosclerosis and cardiovascular disease. This Focused Issue of Cardiovascular Research addresses this issue by illustrating the different aspects of the correlation between oxidative stress and cardiovascular disease and by reviewing the current status of antioxidant therapy.

As research progresses and epidemiological and clinical trials of antioxidants are being reported, an apparent contradiction emerges: while appropriate diets with a high proportion of antioxidants are able to afford protection from coronary heart disease, supplementation studies with individual antioxidants are yielding mostly negative results [3]. Further, basic research is continuously discovering new roles played by an excessive production of reactive oxygen species in the different aspects of cardiovascular disease, including plaque instability, impaired vasomotor reactivity, and increased risk of coronary artery disease in diabetes mellitus, to name just a few. In turn, the rationale for the therapeutic use of antioxidants appears to be sound but, in part because of the current insufficiency of appropriate in vivo markers of oxidative stress, the correct approach to antioxidant therapy is still lacking [4]. It should also be pointed out that the in vivo processes of lipid peroxidation that lead to atherosclerosis are yet to be fully elucidated: oxidants such as HOCl – toward which the current supplementation strategies would be inactive – may play a major role [5].

We hope that the readers will find this issue of Cardiovascular Research stimulating and we hope that it will further stimulate research in the field of oxidant/antioxidant biochemistry and its clinical applications.


   References
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  1. Keys A. Mediterranean diet and public health: personal reflections. Am J Clin Nutr (1995) 61:1321S–1323S.[Medline]
  2. Diaz M.N., Frei B., Vita J.A., Keaney J.F. Antioxidants and atherosclerotic heart disease. N Eng J Med (1997) 337:408–416.[Free Full Text]
  3. Marchioli R. Antioxidant vitamins and prevention of cardiovascular disease: laboratory, epidemiological and clinical trial data. Pharmacol Res (1999) 40:227–238.[CrossRef][Web of Science][Medline]
  4. Halliwell B. The antioxidant paradox. Lancet (2000) 355:1179–1180.[CrossRef][Web of Science][Medline]
  5. Carr A., Tijerina T., Frei B. Vitamin C protects against and reverses specific hypochlorous acid- and chloramine-dependent modifications of low-density lipoprotein. Biochem J (2000) 346:491–499.[CrossRef][Web of Science][Medline]

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