Antioxidant therapy for the prevention of cardiovascular disease

Coronary artery disease (CAD) is the major cause of death in developed countries.1 It may present as a typical `heart attack', as sudden death, or it may be detected at a later date and be described as a silent infarct. Good coronary care units, the use of thrombolytic and anti-arrhythmic drugs, and accurate methods for assessing cardiac function and coronary artery pathology have all successfully reduced in-hospital mortality. However, about 75% of those who have a myocardial infarction (MI) die outside hospital,2 and sudden death is the first and only manifestation in about 20% of all those who present with CAD.3,,4 Therefore, treatment is not available for most patients, and the aim must be to prevent the development and progression of CAD. There are five conditions that predispose to premature death from CAD. These are: hypertension;5,,6 hypercholesterolaemia;7,,8 the post-menopausal state;9,,10 a thrombotic tendency;11,,12 and the risk of developing ventricular arrhythmias.13 Patients with any of these conditions may be offered appropriate pharmacological treatment. In addition, those known to have CAD because they have had a MI or suffer from angina or strongly suspected of having CAD, because they have cerebrovascular or peripheral vascular disease, should also be offered secondary preventive treatment with, for example, lipid-lowering therapy and aspirin. All the above patient groups and the general population can be offered lifestyle advice, which may be considered under five headings: (i) smoking cessation;14,,15 (ii) weight control;16,,17 (iii) taking reasonable exercise;18,,19 (iv) eating a proper diet;20,,21 and (v) taking antioxidant therapy.22–,24 The purpose of this review is to consider the role of antioxidants as a means of reducing the risk …