Levels of ROS are increased in almost every CVD. For example, ischemia reperfusion associated with MI or stroke causes a burst of ROS in mitochondria. 8 Angiotensin II, and cytokines that are upregulated in HF increase ROS from NADPH oxidase. 9 Macrophage-derived foam cells release ROS in atherosclerotic plaques. 10 In addition, increments in ROS exacerbate CVD. For example, mouse studies show that deletion of antioxidant enzymes, including superoxide dismutase (SOD) 11,12 and glutamate-cysteine ligase modifier subunit (Gclm), 13 exacerbates ischemic reperfusion injury. SOD1 or SOD2 knockout (KO) mice also experience worsened stroke, 14,15 and mice deficient in SOD2 16 or Gclm 17 have impaired cardiac function in HF. Furthermore, genetic polymorphisms in antioxidant enzymes, such as SOD2 18 and Gclm, 17,19,20 are also a risk factor for CVD. Therefore, it would be expected that treating CVD with antioxidants might be a good strategy. Actually, overexpression of antioxidant enzymes such as SOD or glutathione peroxidase (Gpx), as well as treatment with the free radical scavengers, edaravone or tempol, improves animal models of MI, 21,22 ischemic reperfusion 23-27 and stroke 28,29 (Table). In addition, clinical studies showed that edaravone, which has eactive oxygen species (ROS) are generated mainly as result of cellular respiration, and they are maintained at low levels by antioxidant molecules and enzymes. 1 It is well known that ROS are increased in cardiovascular diseases (CVD), such as myocardial infarction (MI), stroke, heart failure (HF), atherosclerosis and peripheral arterial disease. 2 Increased ROS are considered a consequence of CVD, particularly as they are produced by inflammatory leukocytes, and in addition may exacerbate disease because of deleterious cellular effects caused by "oxidative stress". 3 Therefore, eliminating ROS would seem a promising strategy for treatment of CVD, particularly based on results of animal studies. However, the results of clinical trials have been far below this expectation. 4 ROS are now recognized not only as cytotoxic molecules but also as cell signaling mediators. 5 Little is known about the effects of ROS related to signaling in CVD. However, animal studies show that ROS contribute to improvement of CVD, including angiogenesis following ischemia. 6,7 In this review, we summarize the results of antioxidants used in clinical trials and mouse CVD models, the mechanism by which ROS regulate cell signaling, and discuss how ROS influence angiogenesis. We especially focus on ROS-induced signaling by S-glutathionylation or GSH protein adducts, which are a relatively stable oxidative post-translational protein modification. Antioxidants are expected to improve cardiovascular disease (CVD) by eliminating oxidative stress, but clinical trials have not shown promising results in chronic CVD. Animal studies have revealed that reactive oxygen species (ROS) exacerbate acute CVDs in which high levels of ROS are observed. However, ROS are also necessary for angiogenesis after ischem...