The Role of Oxidative Stress in Cardiac Disease: From Physiological Response to Injury Factor

Figure 1

Summary of the main antioxidant therapy approaches in the clinical setting. Multiple studies have assessed different approaches: inhibition of oxidative stress producers (i.e., inhibition of xanthine oxidase with oxypurinol or allopurinol administration and inhibition of NOS uncoupling with BH₄), improvement of endogenous antioxidant capacity (i.e., NAC administration), supplementation of exogenous antioxidants (i.e., administration of omega-3 fatty acids EPA and DHA, antioxidant vitamins C and E, and olive oils), and administration of drugs with anti-inflammatory and antioxidant properties (i.e., statins). The main mechanisms of action are also described. BH₄: tetrahydrobiopterin; DHA: docosahexaenoic acid; EPA: eicosapentaenoic acid; HF: heart failure; iNOS: inducible nitric oxide synthase; LVEF: left ventricular ejection fraction; LDL: low-density lipoproteins; MDA: malondialdehyde; NAC: N-acetyl cysteine; NO: nitric oxide; NOS: nitric oxide synthase; PGC1α: peroxisome proliferator-activated receptor gamma coactivator gene-alpha; POAF: postoperative atrial fibrillation; ROS: reactive oxygen species; SIRT1: sirtuin-1.