Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Leipziger Str. 40, 39120, Magdeburg, Germany.
Curr Vasc Pharmacol. 2021;19(1):41-54. doi: 10.2174/1570161118666200317151553.
In end-stage renal disease patients, the leading causes of mortality are of cardiovascular (CV) origin. The underlying mechanisms are complex, given that sudden heart failure is more common than acute myocardial infarction. A contributing role of oxidative stress is postulated, which is increased even at early stages of chronic kidney disease, is gradually augmented in parallel to progression to endstage renal disease and is further accelerated by renal replacement therapy. Oxidative stress ensues when there is an imbalance between reactive pro-oxidants and physiologically occurring electron donating antioxidant defence systems. During the last decade, a close association of oxidative stress with accelerated atherosclerosis and increased risk for CV and all-cause mortality has been established. Lipid peroxidation has been identified as a trigger for endothelial dysfunction, the first step towards atherogenesis. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from studies that test antioxidants for CV protection, such as vitamins E and C, statins, omega-3 fatty acids and N-acetylcysteine.
在终末期肾病患者中，导致死亡的主要原因是心血管（CV）源性的。由于心力衰竭比急性心肌梗死更为常见，潜在的机制非常复杂。有人推测氧化应激起一定作用，即使在慢性肾脏病的早期，氧化应激就已经增加，随着疾病进展到终末期肾病，氧化应激逐渐增强，而肾脏替代治疗则进一步加速了氧化应激。当活性促氧化剂和生理性电子供体抗氧化防御系统之间的平衡被打破时，就会发生氧化应激。在过去的十年中，氧化应激与动脉粥样硬化加速以及心血管和全因死亡率增加之间的密切关联已经确立。脂质过氧化已被确定为内皮功能障碍的触发因素，这是动脉粥样硬化形成的第一步。为了抵消自由基的有害影响，从而改善或延缓心血管疾病，已经提出了外源性抗氧化剂的应用。在这里，我们尝试总结现有研究的数据，这些研究测试了抗氧化剂对心血管的保护作用，如维生素 E 和 C、他汀类药物、欧米伽-3 脂肪酸和 N-乙酰半胱氨酸。
