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Vitamin C: Can It Help to Prevent Cardiovascular Disease?

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Submitted By gauldy
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Introduction
As of last year, it was reported that over a million Canadians have heart disease, which also ranks as one of the major causes of death in Canada 1. Additionally, cardiovascular disease claims more than 33,000 lives each year. Furthermore, about ninety percent (9 out of 10) Canadians over the age of twenty years have at least one risk factor for heart disease, and of this number, forty percent (4 out of ten 10) have three or more risk factors 1. Various factors can increase the risk of heart disease - some of which can be controlled while others cannot. The uncontrollable risk factors include age, ethnicity and having a family history of heart disease; but controllable risk factors mainly comprise making lifestyle or behavioral changes such as smoking cessation and avoiding excessive alcohol consumption, eating healthy, exercising regularly and reducing stress 1. Consequently, an individual can reduce their risk of heart disease by understanding the risk factors that cause it, and making changes to their lifestyle.
The Dietary Guidelines for Canadians (Eating Healthy with Canada’s Food Guide) describes a healthful diet as one that emphasizes a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products 2. Fruits and some vegetables are excellent sources of vitamin C, which is a water soluble vitamin. Fruits with the highest sources of vitamin C include cantaloupe, citrus fruits and juices, such as orange and grapefruit kiwi fruit mango and papaya among others, whereas vegetables that have vitamin C comprise broccoli, cauliflower, green and red bell peppers, and brussels sprout 2.
Vitamin C – as an antioxidant – functions by helping to neutralize the action of free radicals, which are substances that damage DNA and cells or tissue 5. With time, the build up of free radicals is known to accelerate the aging process as well as the development of chronic diseases such as cardiovascular disease, cancer and arthritis 2. This paper aims to give a brief overview of the impact of vitamin C on cardiovascular disease.

The case for vitamin C in cardiovascular disease
Various studies have examined the role of vitamin C in regards to preventing chronic diseases that are triggered by oxidative stress, such as cardiovascular disease; however, reports on such studies are not consistent. For instance, few clinical studies such as the Women's Antioxidant Cardiovascular Study (WACS) reported no significant impact of vitamin C supplementation on the prevention of either primary or secondary cardiovascular disease 3. Furthermore, in a longitudinal study that comprised 8,171 women, aged 40 years or older with a history of cardiovascular disease, it was reported that supplementation with 500 mg/day vitamin C over a ten-year average period did not demonstrate significant overall benefit on cardiovascular health 4.
Nevertheless, numerous epidemiological studies and clinical interventions have reported on the significant cardiovascular benefits of vitamin C. Researchers have explained that during the initial stages of atherosclerosis, monocytes (a form of white blood cells) migrate and adhere to the walls of the endothelium. This causes blood vessel walls to lose their elasticity and become narrow, causing atherosclerosis 2. Carr and Frei (1999) reported that, along with its antioxidant properties, vitamin C helps to reduce monocyte adherence to the endothelium (and diminishes plaque formation); improve endothelium-dependent nitric oxide production and/or vasodilation; as well as reduce vascular smooth-muscle-cell apoptosis, which prevents plaque instability in atherosclerosis 2.
The health benefits of vitamin C supplementation (250 mg/day) were studied in the United Kingdom (Britain) on adhesion of monocytes in forty healthy adults. Prior to the study, it was determined that subjects who had low (plasma) levels of vitamin C had a monocyte adhesion rate of thirty-percent, which placed them at high risk for atherosclerosis.
However, six weeks post-supplementation, monocyte adhesion rate dropped by thirty-seven percent 7. Furthermore, a recent prospective study in 20,649 British adults found that people with elevated plasma vitamin C concentrations had a forty-two percent lower risk of stroke compared to people who did not 6.
Finally, vitamin C has been shown to provide cardiovascular benefit in people who are either exposed to smoking or smoke. Smoking has been linked with high levels of C-reactive protein (CRP), an inflammatory marker that is associated with cardiovascular disease 8. At the University of Berkeley in California, investigators looked at the effect of antioxidant supplementation on plasma levels of CRP in a hundred-and-sixty people who either smoked or were exposed to smoke. Participants were either assigned to a placebo, vitamin C (515 mg/day), or an antioxidant combination (including vitamins C, E, and lipoic acid) group. Results showed that participants in the vitamin C group had a significant twenty-four percent reduction in blood CRP concentrations, but none of the other treatment groups showed a significant change 8. Studies also suggest that the antioxidant function of vitamin C helps to alter the oxidative actions of low-density lipoproteins, which have been implicated in cardiovascular disease 5.

Conclusion
Despite the mixed results, or the fact that some clinical trials that examined the effects on cardiovascular disease combined vitamin C with other antioxidants (such as vitamin E and beta carotene) and made it difficult to fully deduce the potential contribution of vitamin C, there is no doubt that the health benefits of this antioxidant has great potential in our quest o stem the tide for the increasing problem of chronic diseases such as cardiovascular disease.
To prevent vitamin C deficiency, it is strongly recommended that men should take 125 mg for and women should take 110 mg daily, but clinical studies indicate that for optimal wellness and health, people should consume about 400 mg/day 3.
In a nutshell, the results on vitamin C’s impact on cardiovascular health cannot be overemphasized, but more research needs to be done in order to fully uncover the health benefits of this antioxidant on human health.

References
1. Public Health Agency of Canada. 2009 Tracking Heart Disease and Stroke in Canada. Accessed online September 15, 2015 at: http://www.phac-aspc.gc.ca/publicat/2009/cvd-avc/index-eng.php

2. Health Canada. Eating Well with Canada’s Food Guide. Accessed online September 19, 2015 at: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

3. Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr 1999; 69:1086-107.

4. Cook NR, Albert CM, Gaziano JM, Zaharris E, MacFadyen J, Danielson E, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women's Antioxidant Cardiovascular Study. Arch Intern Med 2007; 167:1610-8.

5. Sesso HD, Buring JE, Christen WG, Kurth T, Belanger C, MacFadyen J, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. JAMA 2008; 300:2123-33.

6. Myint PK, Luben RN, Welch AA, Bingham SA, Wareham NJ, Khaw KT. Plasma vitamin C concentrations predict risk of incident stroke over 10 y in 20,649 participants of the European Prospective Investigation into Cancer Norfolk prospective population study. Am J Clin Nutr 2008; 87:64-9.

7. Woollard KJ, Loryman CJ, Meredith E, et al. Effects of oral vitamin C on monocyte: endothelial cell adhesion in healthy subjects. Biochem Biophys Res Commun. 2002 Jun 28; 294(5):1161-8.

8. Block G, Jensen C, Dietrich M, et al. Plasma C-reactive protein concentrations in active and passive smokers: influence of antioxidant supplementation. J Am Coll Nutr. 2004 Apr; 23(2):141-7.

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