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Clinical Review Evidence based cardiology

Emerging approaches in preventing cardiovascular disease

BMJ 1999; 318 doi: (Published 15 May 1999) Cite this as: BMJ 1999;318:1337
  1. Eva M Lonn, associate professor (⇑,
  2. Salim Yusuf, professor
  1. Division of Cardiology, Hamilton Health Sciences Corporation, General Site, Hamilton, ON L8L 2X2, Canada
  1. Correspondence to: Dr Lonn

This is the first of four articles

Reducing cholesterol and blood pressure, as well as smoking cessation, have been shown to be effective strategies for preventing cardiovascular diseases.1 However, these “classical” risk factors, along with known non-modifiable risk factors such as age, sex, and family history, cannot fully explain why some people develop myocardial infarction and stroke, while others do not.24 Additional factors may have a role in the pathogenesis of atherosclerosis, and new preventive strategies may be of use. In this article we briefly review the use of antioxidants, the use of angiotensin converting enzyme inhibitors, and homocysteine lowering; other “emerging” cardiovascular risk factors and potential preventive strategies that are under investigation are summarised in table 1.

Summary points

Classical risk factors for atherosclerosis cannot fully explain why certain people develop coronary heart disease and stroke, while others do not

Other potential (“emerging”) risk factors for atherosclerosis and new preventive therapies are currently being studied

Promising new preventive therapies include antioxidants, lowering of homocysteine concentrations, decreasing the activation of the renin-angiotensin and the coagulation systems, antibiotics, and anti-inflammatory agents

These therapies have not been proved in clinical trials; at present, the emphasis should be on treating established risk factors and consistently applying therapies that are known to reduce cardiovascular morbidity and mortality

Oxidative stress and antioxidants

Extensive laboratory data show that oxidative modification of low density lipoprotein cholesterol is an important step in the pathogenesis of atherosclerosis, and experimental studies in different animal models show that antioxidants decrease oxidation of low density lipoprotein cholesterol and reduce plaque formation. 5 6

Epidemiological studies have generally reported that increased intake of antioxidants through diet or supplements, particularly vitamins E and C and β carotene, is associated with a lower risk of coronary heart disease.79 Other antioxidants, such as other …

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