Volume 72 Number 2 March 2005	back to contents

Instructor of Medicine, the Zena and Michael Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY.

Address all correspondence to W. Lane Duvall, M.D., The Zena and Michael Wiener Cardiovascular Institute, Box 1030, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029; e-mail: william.duvall@msnyuhealth.org

Adapted from a Cardiology Grand Rounds, Controversies in Cardiology presentation to the Department of Medicine, Mount Sinai School of Medicine, New York, NY on January 27, 2003 and updated as of February 2004.

ABSTRACT

The vascular endothelium plays a crucial role in the physiology of blood vessels and the pathological processes of atherosclerotic disease and acute coronary syndromes. Endothelial dysfunction is the core problem; it is an impairment of endothelium-dependent vasorelaxation caused by a loss of nitric oxide activity in the vessel wall, which results in impairment in the regulation of vascular homeostasis. Further understanding of its mechanisms of action and possible therapeutic targets will be of great importance. The group of antioxidant vitamins, A, C and E, would seem uniquely situated to reduce cardiovascular events by improving endothelial function by reducing the concentration of reactive oxygen species in the vessel wall and by preventing oxidative modification of low-density lipoprotein. Unfortunately, despite extensive studies in both observational and randomized trials, the weight of evidence points to little or no benefit from antioxidant therapy.

KEYWORDS

Endothelium dysfunction, endothelium, antioxidants, vitamins.

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