Is there a role for antioxidants in the treatment of stable angina?

Medical treatment plays an important role in the therapy of coronary artery disease and stable angina. Whereas nitrates are used to improve symptoms, beta-blockers, statins, and ACE-inhibitors/angiotensin receptor blockers are given also to target prognosis in part by slowing the progression of disease. Major cardiovascular risk factors including tobacco smoking, physical inactivity, obesity, arterial hypertension, hyperlipidemia, and diabetes mellitus were associated with overproduction of reactive oxygen species (ROS). In animal models, increased ROS production was associated with the initial steps of atherosclerosis including vascular cell dysfunction, intimal hypertrophy, the formation and destabilization of plaque. As a consequence, ROS were believed to be major contributors to the development of cardiovascular diseases and antioxidant treatments were proposed as promising therapeutic strategies. Nevertheless, intervention studies with antioxidant vitamins have failed to positively affect cardiovascular outcome in prospective trials. Specific inhibitors of prooxidant enzymes are being developed but their efficacy to improve cardiovascular endpoints has not been tested so far. Newer evidence suggests that phytonutrients including flavanols may posses vascular protective effects that are independent of their antioxidant properties observed in vitro. Taken together, there is currently not enough evidence that treatment with antioxidants per se will play a role in cardiovascular medicine.