Leopold Jane A
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Coron Artery Dis. 2015 Mar;26(2):176-83. doi: 10.1097/MCA.0000000000000187.
Oxidant stress in the cardiovascular system may occur when antioxidant capacity is insufficient to reduce reactive oxygen species and other free radicals. Oxidant stress has been linked to the pathogenesis of atherosclerosis and incident coronary artery disease. As a result of this connection, early observational studies focused on dietary antioxidants, such as β-carotene, α-tocopherol, and ascorbic acid, and demonstrated an inverse relationship between intake of these antioxidants and major adverse cardiovascular events. These findings supported a number of randomized trials on the use of selected antioxidants as primary or secondary prevention strategies to decrease cardiac risk; however, many of these studies reported disappointing results with little or no observed risk reduction in antioxidant-treated patients. Several plausible explanations for these findings have been suggested, including incorrect antioxidant choice or dose, synthetic versus dietary antioxidants as the intervention, and patient selection, all of which will be important to consider when designing future clinical trials. This review will focus on the contemporary evidence that is the basis for our current understanding of the role of antioxidants in cardiovascular disease prevention.
当抗氧化能力不足以减少活性氧和其他自由基时，心血管系统中可能会出现氧化应激。氧化应激与动脉粥样硬化的发病机制和冠心病的发生有关。由于这种联系，早期的观察性研究集中在膳食抗氧化剂上，如β-胡萝卜素、α-生育酚和抗坏血酸，并证明这些抗氧化剂的摄入量与主要不良心血管事件之间存在负相关。这些发现支持了一些关于使用特定抗氧化剂作为一级或二级预防策略以降低心脏风险的随机试验；然而，这些研究中有许多报告了令人失望的结果，抗氧化剂治疗的患者几乎没有或没有观察到风险降低。对于这些发现，已经提出了几种合理的解释，包括抗氧化剂选择或剂量不当、作为干预措施的合成抗氧化剂与膳食抗氧化剂以及患者选择，所有这些在设计未来临床试验时都将是重要的考虑因素。本综述将关注当代证据，这些证据是我们目前对抗氧化剂在心血管疾病预防中作用理解的基础。
