Gaziano J M
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02215-1204, USA.
J Cardiovasc Risk. 1996 Aug;3(4):368-71. doi: 10.1177/174182679600300406.
The hypothesis that antioxidant vitamins might reduce cardiovascular disease risk is based on a large body of basic and human epidemiologic research. Basic research provides a plausible mechanism by which antioxidants might reduce the risk of atherosclerosis. A large number of descriptive, case-control and cohort studies provide data suggesting that consumption of antioxidant vitamins is associated with reduced risks of cardiovascular disease. These data raise the question of a role of antioxidants, such as vitamins C and E, and beta-carotene, in the primary prevention of cardiovascular disease, but do not provide a definitive answer. Randomized trial data will be essential in establishing whether or not there is a causal effect of antioxidants in reducing the risk of cardiovascular disease. For many hypotheses randomized trials are neither necessary nor desirable; however, when searching for small to moderate effects, large-scale randomized trials of adequate dose and duration, in which investigators allocate subjects at random to either active treatment or placebo will provide valuable information about whether there is a causal relationship, and provide reliable estimates of effect size. Results from several large-scale randomized trials of antioxidants are summarized in this paper. At present, there is not sufficient data available to define clearly the role of antioxidants in primary or secondary prevention of cardiovascular disease. Additional trial data should be forthcoming in the near future which will aid in individual clinical decision-making and in the establishment of guidelines for the general public.
抗氧化维生素可能降低心血管疾病风险这一假说，是基于大量基础研究和人体流行病学研究得出的。基础研究提供了一种合理的机制，通过该机制抗氧化剂可能降低动脉粥样硬化风险。大量描述性研究、病例对照研究和队列研究提供的数据表明，摄入抗氧化维生素与心血管疾病风险降低有关。这些数据引发了关于抗氧化剂（如维生素C、维生素E和β-胡萝卜素）在心血管疾病一级预防中作用的问题，但并未给出明确答案。随机试验数据对于确定抗氧化剂在降低心血管疾病风险方面是否存在因果效应至关重要。对于许多假说而言，随机试验既不必要也不可取；然而，在寻找小到中等程度的效应时，大规模、足够剂量和持续时间的随机试验（研究者将受试者随机分配到活性治疗组或安慰剂组）将提供关于是否存在因果关系的有价值信息，并能提供效应大小的可靠估计。本文总结了几项抗氧化剂大规模随机试验的结果。目前，尚无足够数据能明确抗氧化剂在心血管疾病一级或二级预防中的作用。在不久的将来应该会有更多试验数据，这将有助于个体临床决策以及制定针对普通大众的指南。
