The low density lipoprotein (LDL) oxidation hypothesis has generated considerable interest in oxidative stress and how it might affect atherosclerosis. However, the failure of antioxidants, particularly vitamin E, to affect the progression of the disease in humans has convinced even staunch supporters of the hypothesis to take a step backwards and reconsider alternatives.Preponderant evidence for the hypothesis came from animal antioxidant intervention studies. In this review we point out basic differences between animal and human atherosclerosis development and suggest that human disease starts where animal studies end. While initial oxidative steps in the generation of early fatty streak lesions might be common, the differences might be in the steps involved in the decomposition of peroxidized lipids into aldehydes and their further oxidation into carboxylic acids. We suggest that these steps may not be amenable to attenuation by antioxidants and antioxidants might actually counter the stabilization of plaque by preventing the formation of carboxylic acids which are anti-inflammatory in nature. The formation of such dicarboxylic acids may also be conducive to plaque stabilization by trapping calcium.We suggest that agents that would prevent the decomposition of lipid peroxides and promote the formation and removal of lipid hydroxides, such as paraoxonase (PON 1) or apo A1/high density lipoprotein (HDL) might be more conducive to plaque regression.
KeywordsAtherosclerosis; aldehydes; dicarboxylation; inflammation; calcification
Oxidation hypothesis of atherosclerosisAtherosclerosis is the major manifestation of cardiovascular diseases. The role of lipoproteins in atherosclerosis development has been a topic of interest for over five decades. It is now established beyond doubt that high levels of low density lipoprotein (LDL) and low levels of high density lipoprotein (HDL) contribute significantly to the development and progression of cardiovascular diseases [1][2][3][4][5].The biochemical processes that contributed to the formation of early atherosclerotic lesions, the fatty streak lesions, are still under debate. The LDL oxidation hypothesis was put forward in the eighties to explain the formation of fatty streak lesions and over 4000 publications and countless reviews have appeared on the topic to date [6][7][8][9][10][11] providing evidence for the presence *Address correspondence to: Sampath Parthasarathy, Ph.D., M.B.A*. N-850 Doan Hall, 410 W. 10 th Avenue, Ohio State University, Columbus, OH 43210, Tel: (614) Fax: (614) 292-9259, E-mail: spartha@osumc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all ...