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Low Vitamin C Levels Appear to Increase Risk for Heart Failure Patients

Heart failure patients who don’t eat enough vitamin C-rich foods have more inflammation and a higher risk of cardiac complications and death

Nov.13, 2011 - A study presented yesterday at the American Heart Association’s Scientific Sessions 2011, claims a new study is the first to demonstrate that low vitamin C intake is associated with worse outcomes for heart failure patients.

The low levels of vitamin C were associated with higher levels of high sensitivity C-Reactive protein (hsCRP), and shorter intervals without major cardiac issues or death for heart failure patients, in research presented at the meeting in Orlando, Fla.

Compared to those with high vitamin C intake from food, heart failure patients in the study who had low vitamin C intake were 2.4 times more likely to have higher levels of hsCRP, a marker for inflammation and a risk factor for heart disease.

Study participants with low vitamin C intake and hsCRP over 3 milligrams per liter (mg/L) were also nearly twice as likely to die from cardiovascular disease within one year of follow-up.


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“We found that adequate intake of vitamin C was associated with longer survival in patients with heart failure,” said Eun Kyeung Song, Ph.D., R.N., lead author of the study and assistant professor at the Department of Nursing, College of Medicine, in the University of Ulsan in Korea.

The average age among the 212 patients in the study was 61, and about one-third were women. Approximately 45 percent of the participants had moderate to severe heart failure.

Participants completed a four-day food diary verified by a registered dietitian and a software program calculated their vitamin C intake. Bloods tests measured hsCRP.

Researchers divided participants into one group with levels over 3 mg/L of hsCRP and another with lower levels. Patients were followed for one year to determine the length of time to their first visit to the emergency department due to cardiac problems or death.

Researchers found that 82 patients (39 percent) had inadequate vitamin C intake, according to criteria set by the Institute of Medicine.

These criteria allowed the researchers to estimate the likelihood that the patient’s diet was habitually deficient in vitamin C based on a four day food diary.

After a year follow-up, 61 patients (29 percent) had cardiac events, which included an emergency department visit or hospitalization due to cardiac problems, or cardiac death.

The researchers found that 98 patients (46 percent) had hsCRP over 3 mg/L, according to Song.

Inflammatory pathways in heart failure patients may be why vitamin C deficiency contributed to poor health outcomes, the data suggests.

“Increased levels of high-sensitivity C-reactive protein means a worsening of heart failure,” Song said. “An adequate level of vitamin C is associated with lower levels of high-sensitivity C-reactive protein. This results in a longer cardiac event-free survival in patients.”

The use of diuretics may also play a role because vitamin C is water soluble and diuretics increase the amount of water excreted from the kidneys, said Terry Lennie, Ph.D., R.N., study author and associate dean of Ph.D. studies in the College of Nursing at the University of Kentucky in Lexington, Kentucky.

“Diet is the best source of vitamin C,” Lennie said. “Eating the recommended five servings of fruits and vegetables a day provides an adequate amount.”

More randomized controlled trials and longitudinal prospective studies are needed to determine the impact of other micronutrients on survival or re-hospitalization, Song said.

Other co-authors are Debra K. Moser, D.N.Sc., R.N.; Heather Payne-Emerson, Ph.D., R.D.; Sandra B. Dunbar, D.S.N., R.N. and Susan J. Pressler, Ph.D., R.N.

More information below about Heart Failure and Vitamin C

About Heart Failure

Heart failure is a condition in which the heart can't pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should.

The weakening of the heart's pumping ability causes
   ● Blood and fluid to back up into the lungs
   ● The buildup of fluid in the feet, ankles and legs - called edema
   ● Tiredness and shortness of breath

The leading causes of heart failure are coronary artery disease, high blood pressure and diabetes.

Treatment includes treating the underlying cause of your heart failure, medicines, and heart transplantation if other treatments fail.

Heart failure is a serious condition. About 5 million people in the U.S. have heart failure. It contributes to 300,000 deaths each year.

NIH: National Heart, Lung, and Blood Institute

>> Interactive Tutoral on Congestive Heart Failure

Heart Failure Facts (Centers for Disease Control and Prevention)

   ● Heart failure occurs when the heart cannot pump enough blood and oxygen to support other organs. Heart failure is a serious condition, but it does not mean that the heart has stopped beating.

   ● Around 5.8 million people in the United States have heart failure. About 670,000 people are diagnosed with it each year.1

About one in five people who have heart failure die within one year from diagnosis.1

   ● Heart failure was a contributing cause of 282,754 deaths in 2006.1

   ● In 2010, heart failure will cost the United States $39.2 billion.1 This total includes the cost of health care services, medications, and lost productivity.

   ● The most common causes of heart failure are coronary artery disease, high blood pressure, and diabetes.

   ● Early diagnosis and treatment can improve quality of life and life expectancy for people who have heart failure. Treatment usually involves taking medicines, reducing salt in the diet, and getting daily physical activity. People with heart failure also track their daily symptoms and discuss them with their doctors.


Common symptoms of heart failure include -

   ● Shortness of breath during daily activities.

   ● Having trouble breathing when lying down.

   ● Weight gain with swelling in the legs, ankles, or lower back.

   ● General fatigue and weakness.

For More Information

For more information on CDC’s National Heart Disease and Stroke Prevention Program, visit

For more information about congestive heart failure, visit the Web sites of the following organizations:

Centers for Disease Control and Prevention

American Heart Association*

National Heart, Lung, and Blood Institute

Heart Failure Society of America*

Vitamin C sourceAbout Vitamin C

Vitamin C is an antioxidant. Antioxidants are substances that may protect your cells against the effects of free radicals. Free radicals are molecules produced when your body breaks down food, or by environmental exposures like tobacco smoke and radiation. Vitamin C is important for your skin, bones, and connective tissue. It promotes healing and helps the body absorb iron.

Vitamin C comes from fruits and vegetables. Good sources include citrus, red and green peppers, tomatoes, broccoli, and greens. Some juices and cereals have added vitamin C.

Some people may need extra vitamin C:

   ● Pregnant/breastfeeding women

   ● Smokers

   ● People recovering from surgery

All fruits and vegetables contain some amount of vitamin C.

Foods that are the highest sources of vitamin C include:

·        Cantaloupe

·        Citrus fruits and juices, such as orange and grapefruit

·        Kiwi fruit

·        Mango

·        Papaya

·        Pineapple

·        Strawberries, raspberries, blueberries, cranberries

·        Watermelon

·        Vegetables that are the highest sources of vitamin C include:

·        Broccoli, Brussels sprouts, cauliflower

·        Green and red peppers

·        Spinach, cabbage, turnip greens, and other leafy greens

·        Sweet and white potatoes

·        Tomatoes and tomato juice

·        Winter squash

Some cereals and other foods and beverages are fortified with vitamin C. Fortified means a vitamin or mineral has been added to the food. Check the product labels to see how much vitamin C is in the product.

Cooking vitamin C-rich foods or storing them for a long period of time can reduce the vitamin C content. Microwaving and steaming vitamin C-rich foods may reduce cooking losses. The best food sources of vitamin C are uncooked or raw fruits and vegetables.

Side Effects

Serious side effects from too much vitamin C are very rare, because the body cannot store the vitamin. However, amounts greater than 2,000 mg/day are not recommended because such high doses can lead to stomach upset and diarrhea.

Vitamin C (National Institutes of Health, Office of Dietary Supplements)

>> More information Medline Plus

>> Top 10 Sources of Vitamin C (Including 3 Foods With more than Oranges)

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