Cardiovascular disease remains the major cause of death and disability in the UK. The assessment of cardiovascular risk is an important part of ensuring that resources are used most effectively to prevent disease. However, conventional risk factors do not adequately predict which individuals will, or will not, go on to develop cardiovascular disease. The search for novel risk markers continues, and their discovery may also provide insights into the cause of disease.
Atherogenesis, the complex process that underlies cardiovascular disease, is characterised by inflammation of blood vessels and autoimmunity. Free radicals are highly reactive molecules that are produced during normal metabolism, which can damage proteins within the body. Proteins damaged in this way may be restored to their normal configuration by molecular chaperones that are called heat shock proteins. However, these may themselves be altered during this process, which may in turn lead to an activation of the immune system. Antioxidant compounds such as vitamin E, vitamin C and selenium have the potential to assuage the effects of free radicals, and have been shown to be effective in experimental models of atherogenesis and in observational cohort studies. However, the results of intervention trials of antioxidants have generally been negative. A hypothesis explaining this apparent paradox is explained in this lecture.