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J Am Coll Cardiol, 2003; 41:1205-1210, doi:10.1016/S0735-1097(03)00082-2
© 2003 by the American College of Cardiology Foundation
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VIEWPOINT

Antioxidants, statins, and atherosclerosis

Antonio M. Gotto, Jr, MD, DPhil, FACC*,*

* Weill Medical College of Cornell University, New York, New York, USA

Manuscript received June 25, 2002; revised manuscript received December 11, 2002, accepted December 25, 2002.

* Reprint requests and correspondence: Dr. Antonio M. Gotto, Jr, c/o Mr. Jesse Jou, Weill Medical College of Cornell University, 445 East 69th Street, Olin Hall 205, New York, New York 10021, USA.
amg_editorial{at}med.cornell.edu

Research into the oxidation of lipoproteins has yielded many new insights into the pathogenesis of atherosclerosis. However, despite lipoprotein oxidation’s biologically plausible role in atherogenesis, several studies have reported inconsistent effects of antioxidants on clinical coronary end points, in sharp contrast with the studies of lipid modification with the 3-hydroxy-3-methylglutaryl coenzyme A inhibitors, or statins. There appears to be little support for the use of antioxidants in coronary prevention. However, the picture remains incomplete. What are the limitations of available antioxidant studies and the agents used? Until the picture can be clarified, lipid modification with strategies proved to reduce the risk for coronary events, such as statins or dietary changes in the style of the Mediterranean diet, should be better implemented in clinical practice.

Abbreviations and Acronyms
  ASAP = Antioxidant Supplementation in Atherosclerosis Prevention study
  ATBC = Alpha-Tocopherol-Beta-Carotene cancer prevention study
  CAD = coronary artery disease
  CHAOS = Cambridge Heart AntiOxidant Study
  HATS = High-density lipoprotein Atherosclerosis Treatment Study
  HDL-C = high-density lipoprotein cholesterol
  LDL = low-density lipoprotein
  LDL-C = low-density lipoprotein cholesterol
  MI = myocardial infarction
  MVP = MultiVitamins and Probucol study
  SPACE = Secondary Prevention with Antioxidants of Cardiovascular disease in End-stage renal disease study




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