Antioxidants in the prevention of human atherosclerosis. Summary of the proceedings of a National Heart, Lung, and Blood Institute Workshop: September 5-6, 1991, Bethesda, Maryland

The evidence that oxidative modification of low density lipoprotein (LDL) may play an important causative role in atherosclerosis has been increasing rapidly over the past several years.  Some investigators have been sufficiently impressed by the already available epidemiological, biochemical, and experimental animal data to propose clinical intervention trials to test the oxidative modification hypothesis. Ultimately, such tests will be necessary. However, in view of the complexity and cost of clinical trials, one would like to be reasonably sure that any protocol proposed rests on a solid experimental base of information to maximize the chances of a positive result if the hypothesis is correct. Negative results in a badly designed trial might considerably reduce the chances of obtaining the interest and monies necessary for a second chance. For these reasons, it was proposed to the National Heart, Lung, and Blood Institute in September 1990 that a group of experts on various aspects of this problem be convened to assess the available evidence and discuss the possible design of clinical trials.  Dr. Daniel Steinberg, Professor of Medicine at the University of California San Diego, was asked to organize and chair the meeting. The participants brought to the conference table expertise covering a broad range of topics relevant to the oxidative modification hypothesis and to the design of clinical trials. They met in Bethesda on September 5 and 6,1991. The format of the meeting was framed in terms of a series of questions to be discussed in the context of all of the available data. (Author�s abstract)
The workshop provided and overview of the research required on antioxidants. Flaxseed is an excellent source of numerous antioxidants so research is important in the area. Future study was suggested on the mechanisms involved in the oxidative modification of LDL and on the impact of antioxidants.  More animal studies are needed to ascertain how antioxidants protect the LDL against oxidative modification and the influence of these actions on the progression of cardiovascular lesions. Further, additional research is needed on the effects of antioxidants on the later stages of atherosclerosis and on thrombosis. In view of the multiple mechanisms triggered by oxidized LDL, antioxidants could affect fatty streak formation but also the evolution of fatty streaks to fibrous plaques and complicated lesions. (Editor�s comments)