Review is depicted the role of oxidative stress in cardiovascular diseases and therapeutic value of alpha-lipoic acid in improvement of cardiovascular outcomes in patients with established cardiovascular diseases. Some discussable issues regarding endothelial dysfunction and a role of cytoprotection in the way of restoring of mechanical capacities of vascular wall are considered. Particularities of prescription of the alpha-lipoic acid in several cardiovascular diseases are discussed. The results of randomized clinical trials devoted the efficacy of alpha-lipoic acid in preventing the progression of cardiovascular diseases especially in individuals with some comorbidities, i.e. diabetes mellitus and nephropathy, are discussed.