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Original Research Communications |
1 From the British Heart Foundation Cardiovascular Research Unit, the Department of Cardiology and Medicine, the Royal Infirmary of Edinburgh, and the Medical Statistics Unit, University of Edinburgh, Edinburgh, United Kingdom.
Background: Low-fat soluble-antioxidant status is associated with an increased risk of heart disease.
Objective: The aim of this study was to examine whether low plasma concentrations of vitamin C confer an independent risk of acute myocardial infarction (AMI).
Design: Male patients (n = 180) aged <65 y with a first AMI and without an existing diagnosis of angina (>6 mo) who were admitted within 12 h after onset of symptoms were compared with apparently healthy volunteers (n = 177). Plasma concentrations and dietary intakes of vitamin C were determined during hospitalization and 3 mo later.
Results: Compared with the control subjects, the patients had higher total cholesterol and lower HDL-cholesterol concentrations and more of them smoked. The relative risk of AMI for the lowest compared with the highest quintile of plasma vitamin C during hospitalization (14.5 and >60.5 µmol/L, respectively) was 8.37 (95% CI: 3.28, 21.4) after adjustment for classic risk factors. At 3 mo, mean (±SEM) plasma vitamin C concentrations in patients had increased significantly, from 19.6 ± 1.2 to 35.1 ± 1.9 µmol/L (P < 0.001) and no longer conferred a risk of AMI [relative risk: 1.02 (95% CI: 0.51, 2.03)]. Habitual dietary vitamin C intake of patients (before AMI) did not differ significantly from that of control subjects. The increase in plasma vitamin C after recovery from the infarction could not be explained by a similarly large increase in dietary vitamin C.
Conclusions: A low plasma concentration of vitamin C was not associated with an increased risk of AMI, irrespective of smoking status. The apparent risk of AMI due to a low plasma vitamin C concentration was distorted by the acute phase response.
Key Words: Vitamin C • ascorbic acid • acute myocardial infarction • smoking • acute phase response • risk • diet • men • Scotland
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