Abstract 14667: Vitamin C Deficiency, High-Sensitivity C-Reactive Protein, and Cardiac Event-Fee Survival in Patients with Heart Failure
Background. Vitamin C is associated with lower levels of high-sensitivity C-reactive protein (hsCRP), an inflammatory biomarker that predicts cardiovascular disease. However, whether low vitamin C intake is associated with hsCRP and cardiac event-free survival in patients with heart failure (HF) has not been examined.
Purpose. We hypothesized that patients with low vitamin C intake would have higher risk for elevated hsCRP and cardiac events than those with adequate intake of vitamin C.
Method. A total of 212 patients with HF (age 61±12 years, 34% female, 45% NYHA class III/IV) provided blood to measure serum hsCRP and were divided into 2 groups using 3mg/l of hsCRP as a cut-point. Patients completed a 4-day food diary verified with a registered dietitian. Nutrition Data System software program was used to determine intake of vitamin C. Adequacy of vitamin C intake was determined using formulas from the Institute of Medicine. Patients were followed for 1 year to determine time to first event of emergency department visit or hospitalization due to cardiac problems, or cardiac death. Hypotheses were tested by hierarchical logistic and Cox hazard regression.
Results. Eighty-two patients (39%) had inadequate vitamin C intake. During the mean follow-up period of 365 days, 61 patients (29%) had cardiac events. Low vitamin C intake was associated with higher level of hsCRP (odds ratio = 2.4, 95% CI = 1.02-5.75). Low vitamin C intake (hazard ratio [HR] = 2.0, 95% CI = 1.15-3.42) and hsCRP > 3mg/l (HR = 1.9, 95% CI = 1.07-3.48) predicted shorter cardiac event-free survival after controlling for age, gender, body mass index, NYHA class, ejection fraction, comorbidities, total caloric intake and medications.
Conclusion. This is the first study to demonstrate that low vitamin C intake was associated with shorter event-free survival. The data suggest that one possible mechanism by which vitamin C deficiency contributed to poor health outcomes is through inflammatory pathways in HF patients.
- © 2011 by American Heart Association, Inc.