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Cardiovascular Research Advance Access [Accepted Manuscript] published online on December 20, 2008
Cardiovascular Research, doi:10.1093/cvr/cvn354
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Published by Oxford University Press on behalf of the European Society of Cardiology 2008.

Does Reversal of Oxidative Stress and Inflammation Provide Vascular Protection?

Kwang Kon Koh, MD, PhD, Pyung Chun Oh, MD and Michael J. Quon, MD, PhD+

Division of Cardiology, Gachon University, Gil Medical Center, Incheon, Korea
+ Diabetes Unit, Laboratory of Clinical Investigation, NCCAM, NIH, Bethesda, Maryland, USA

Address correspondence to: Kwang Kon Koh, MD, PhD, FACC, FAHA Professor of Medicine Director, Vascular Medicine and Atherosclerosis Unit Division of Cardiology, Gachon University, Gil Medical Center 1198 Kuwol-dong, Namdong-gu Incheon, South Korea 405-760 Tel.: 82-32-460-3683 Fax: 82-32-460-3117 E-mail: kwangk{at}gilhospital.com

Chronic inflammation is a pathogenic feature of atherosclerosis and cardiovascular disease mediated by substances including angiotensin II, proinflammatory cytokines, and free fatty acids. This promotes generation of reactive oxygen species in vascular endothelial cells and smooth muscle cells that mediate injury through several mechanisms.

Reciprocal relationships between endothelial dysfunction and insulin resistance as well as cross-talk between hyperlipidemia and the renin-angiotensin-aldosterone system at multiple levels contribute importantly to a variety of risk factors. Therefore, combination therapy that simultaneously addresses multiple mechanisms for the pathogenesis of atherosclerosis is an attractive emerging concept for slowing progression of atherosclerosis. Combined therapy with statins, peroxisome proliferators-activated receptors, and renin-angiotensin-aldosterone system blockade demonstrates additive beneficial effects on endothelial dysfunction and insulin resistance when compared with monotherapies in patients with cardiovascular risk factors due to both distinct and interrelated mechanisms. These additive beneficial effects of combined therapies are consistent with laboratory and recent clinical studies. Thus, combination therapy may be an important paradigm for treating and slowing progression of atherosclerosis, coronary heart disease, and co-morbid metabolic disorders characterized by endothelial dysfunction and insulin resistance.

KEYWORDS Inflammation; Oxidative Stress; Atherosclerosis; Insulin resistance; Combination therapy

Time for primary review: 31 Days


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