There is clear evidence of lipoprotein oxidation in atherosclerotic lesions. 
Animal studies and observational prospective human cohort studies have been 
interpreted as supporting a role for antioxidants in the prevention of coronary 
heart disease (CHD). However, firm recommendations to take antioxidant 
supplements to treat or prevent CHD require evidence derived from randomised 
controlled studies. In primary prevention studies, low dose alpha-tocopherol 
does not reduce the incidence of coronary events (ATBC study), and beta-carotene 
either has no effect or increases the incidence of coronary events and cancer 
death (ATBC, CARET, Physician's Health studies). Secondary preventions, those 
with smaller populations and shorter duration of follow up have shown some 
benefit from alpha-tocopherol (CHAOS, SPACE), but larger randomised studies 
indicate no benefit from treatment with alpha-tocopherol (HOPE, GISSI, PPP). 
Recent studies with antioxidant combinations also show no benefit (HATS, MPS). 
On the basis of these data, supplements of alpha-tocopherol and beta-carotene 
cannot be recommended for the treatment or prevention of CHD. Fundamental and 
applied research may yet find a role for antioxidant supplements in the 
treatment of coronary disease. However, this will require positive results from 
combined antioxidant studies currently in progress, and the targeting of 
oxidative processes that operate in the artery wall and cause or contribute to 
disease.