Effects of antioxidants on oxidative stress in adult patients with coronary artery disease: A systematic review

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-09-04 DOI:10.1016/j.clnesp.2025.08.037

Islam M. Alhusban , Misook L. Chung , Martha Biddle

{"title":"Effects of antioxidants on oxidative stress in adult patients with coronary artery disease: A systematic review","authors":"Islam M. Alhusban , Misook L. Chung , Martha Biddle","doi":"10.1016/j.clnesp.2025.08.037","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Oxidative stress (OS) accelerates the pathogenesis of coronary artery disease (CAD) by contributing to atherosclerotic plaque formation. Current research indicates that antioxidants can mitigate OS by reducing the production of free radicals. Despite many studies that have tested the effects of antioxidants on oxidative stress in patients with CAD, the literature still lacks an updated and comprehensive systematic review. The aim of this study was to identify the effects of administering exogenous antioxidants on OS levels among adult patients with CAD.</div></div><div><h3>Methods</h3><div>A systematic review searched PubMed, Medline, and CINAHL for randomized controlled trials (RCTs) published between January 2013 and May 2025, which examined antioxidants to lower OS in adult participants with CAD. Studies were excluded if participants had chronic or acute inflammatory conditions, renal failure, liver failure, or had undergone major operations before being enrolled.</div></div><div><h3>Results</h3><div>Among 2338 studies reviewed, 15 RCTs met the inclusion criteria. Out of the 15 RCTs, nine reported on supplemental antioxidants (i.e., L-carnitine and melatonin), and two reported on dietary antioxidants (Khorasan wheat diet and wine) that were effective at lowering OS (P < 0.05). One study found Brazil nuts (dietary antioxidants) ineffective at lowering OS. The three remaining RTCs reported that intravenously administered antioxidants, including alpha-lipoic acid, vitamin C, or N-acetylcysteine, significantly lowered OS.</div></div><div><h3>Conclusions</h3><div>The reviewed RTCs provide evidence that antioxidants may lower OS in patients with CAD. The utility of this conclusion is limited by the studies’ methodologies that examine various antioxidants and measure OS through a variety of biomarkers. This heterogeneity in methodologies between studies indicates that further research is needed with standardized interventions and outcomes.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 794-801"},"PeriodicalIF":2.6000,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nutrition ESPEN","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405457725029262","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Oxidative stress (OS) accelerates the pathogenesis of coronary artery disease (CAD) by contributing to atherosclerotic plaque formation. Current research indicates that antioxidants can mitigate OS by reducing the production of free radicals. Despite many studies that have tested the effects of antioxidants on oxidative stress in patients with CAD, the literature still lacks an updated and comprehensive systematic review. The aim of this study was to identify the effects of administering exogenous antioxidants on OS levels among adult patients with CAD.

Methods

A systematic review searched PubMed, Medline, and CINAHL for randomized controlled trials (RCTs) published between January 2013 and May 2025, which examined antioxidants to lower OS in adult participants with CAD. Studies were excluded if participants had chronic or acute inflammatory conditions, renal failure, liver failure, or had undergone major operations before being enrolled.

Results

Among 2338 studies reviewed, 15 RCTs met the inclusion criteria. Out of the 15 RCTs, nine reported on supplemental antioxidants (i.e., L-carnitine and melatonin), and two reported on dietary antioxidants (Khorasan wheat diet and wine) that were effective at lowering OS (P < 0.05). One study found Brazil nuts (dietary antioxidants) ineffective at lowering OS. The three remaining RTCs reported that intravenously administered antioxidants, including alpha-lipoic acid, vitamin C, or N-acetylcysteine, significantly lowered OS.

Conclusions

The reviewed RTCs provide evidence that antioxidants may lower OS in patients with CAD. The utility of this conclusion is limited by the studies’ methodologies that examine various antioxidants and measure OS through a variety of biomarkers. This heterogeneity in methodologies between studies indicates that further research is needed with standardized interventions and outcomes.

查看原文本刊更多论文

抗氧化剂对成年冠心病患者氧化应激的影响：一项系统综述。

背景：氧化应激（OS）通过促进动脉粥样硬化斑块的形成而加速冠状动脉疾病（CAD）的发病。目前的研究表明，抗氧化剂可以通过减少自由基的产生来减轻OS。尽管许多研究已经测试了抗氧化剂对冠心病患者氧化应激的影响，但文献仍然缺乏更新和全面的系统综述。本研究的目的是确定外源性抗氧化剂对成年冠心病患者OS水平的影响。方法：系统回顾PubMed， Medline和CINAHL在2013年1月至2025年5月期间发表的随机对照试验（rct），这些试验研究了抗氧化剂降低CAD成人患者的OS。如果参与者在入组前患有慢性或急性炎症、肾功能衰竭、肝功能衰竭或经历过大手术，则排除研究。结果：在2338项研究中，有15项rct符合纳入标准。在15项随机对照试验中，9项报道了补充抗氧化剂（即左卡尼汀和褪黑素），2项报道了饮食抗氧化剂（呼罗珊小麦饮食和葡萄酒）可有效降低OS(结论：回顾的随机对照试验提供了抗氧化剂可降低CAD患者OS的证据。这一结论的实用性受到研究方法的限制，这些研究方法检查了各种抗氧化剂，并通过各种生物标志物测量OS。研究方法的异质性表明，需要进一步研究标准化的干预措施和结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.