ABSTRACT

Despite current prevention recommendations and improved treatment outcomes due to advances in surgical techniques, early detection equipment, and the discovery of cholesterol-lowering drugs, coronary artery disease (CAD) remains the number one cause of death in the United States. The exact reasons for the failure of the current approaches to affect the incidence of and mortality from heart disease are unknown. However, it is possible that the major risk factors that initiate and promote damage have not been addressed at the same time, either in prevention or treatment of CAD. These risk factors include increased oxidative stress,1,2 oxidized LDL-cholesterol,3-6 and high levels of C-reactive proteins, a marker of chronic inammation,7 and homocysteine.8 Currently, cholesterol-lowering drugs, with or without niacin, and low-dose aspirin are recommended for reducing the risk and progression of CAD. These recommendations do not affect all risk factors simultaneously. For example, they do not affect oxidative stress and inammation in an optimal manner. In addition, they do not affect either the homocysteine level or its mechanism of action that is mediated via free radicals. Therefore, the use of antioxidants that neutralize free radicals and reduce inammation and B-vitamins that reduce homocysteine levels may affect major risk factors that initiate CAD and, thereby, may reduce the incidence of this disease. A similar approach may improve the efcacy of standard therapy in the treatment of CAD. Modications in diet and lifestyle may improve the efcacy of micronutrient supplements in both prevention and treatment of this disease. Currently, cardiologists recommend modications in diet and lifestyle, but they do not recommend micronutrients, including dietary and endogenous antioxidants for prevention or improving the treatment outcomes of CAD. Previous clinical studies primarily with vitamin E alone in high-risk populations have produced inconsistent results.