ArticlesRelation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study
Introduction
The role of antioxidants in chronic diseases such as cardiovascular disease and cancer is controversial. Evidence from prospective studies suggests that a high dietary intake of antioxidants is protective for cardiovascular disease and cancer, although findings have not been consistent and trial data have not been conclusive.1, 2, 3, 4, 5, 6, 7 Ascorbic acid (vitamin C) plays a part in many biological processes, including free radical scavenging, collagen and hormone synthesis, haemostasis, and protection of lipid membranes which might affect chronic disease risk.8, 9, 10, 11, 12, 13 Investigators in some prospective studies have shown a significant inverse relation between ascorbic acid and cancer or cardiovascular disease, but the protective concentration and the potential size of the relation have varied between these studies. Results of some studies show only increased risk of mortality or cardiovascular disease at very low concentrations,13 but no effect within the usual population range; conversely, those of others indicate only reduced risk in individuals with high concentrations or those who take supplements.12 Findings from trials on the effect of supplementation have shown no change in mortality, but these trials have been generally small and of short duration.14, 15 Most studies have been in men or with data for men and women pooled. Data for women alone are more inconsistent than data on men.13
We present data from a prospective population study examining the relation between plasma ascorbic acid and subsequent mortality due to all causes, cardiovascular disease, ischaemic heart disease, and cancer in men and women.
Section snippets
Participants
The individuals in this analysis were part of EPIC-Norfolk, a prospective population study of 30 466 men and women aged between 45 and 79 years, resident in Norfolk, UK, who completed a baseline questionnaire survey, and of whom 25 663 attended a clinic visit.16 They were recruited from age-sex registers of general practices in Norfolk as part of a nine-country collaborative study (EPIC, European Prospective Investigation into Cancer and Nutrition) designed to investigate dietary and other
Results
Table 1 shows characteristics of the participants according to sex-specific quintile of plasma ascorbic-acid concentration. Ascorbic acid was inversely related to cardiovascular risk factors, including systolic blood pressure and body mass index, and positively to HDL cholesterol. The proportion of individuals who smoked and had a history of diabetes fell as the quintile of ascorbic acid increased. By contrast, the proportion of those who took any supplements rose as the quintile increased.
Discussion
In this population of men and women aged between 45 and 79 years, increasing plasma ascorbic acid concentration was strongly and independently associated with reduction in risk of mortality from all causes, cardiovascular disease, and ischaemic heart disease, with a dose-response relation across the whole population distribution. Although plasma ascorbic acid was measured once only for each individual, the relation with mortality was strong. The assumption is that one value would indicate the
References (30)
- et al.
The Linxian trials: mortality rates by vitamin-mineral intervention group
Am J Clin Nutr
(1995) - et al.
Physiologic levels of ascorbate inhibit the oxidative modification of low density lipoprotein
Atherosclerosis
(1990) - et al.
Vitamin C status and mortality in US adults
Am J Clin Nutr
(2000) - et al.
Antioxidant flavonols and coronary heart disease risk
Lancet
(1997) - et al.
Is there a role for antioxidant vitamins in the prevention of cardiovascular diseases? an update on epidemiological and clinical trials data
Can J Cardiol
(1997) - et al.
Effects of antioxidants on vascular health
Br Med Bull
(1999) - et al.
Antioxidants and coronary heart disease: observational studies
J Cardiovasc Risk
(1996) Randomized trials of dietary antioxidants in cardiovascular disease prevention and treatment
J Cardiovasc Risk
(1996)The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers
N Engl J Med
(1994)- et al.
Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators
N Engl J Med
(2000)
Vitamin C and cardiovascular disease: a systematic review
J Cardiovasc Risk
Carotenoids, vitamins C and E and mortality in an elderly population
Am J Epidemiol
Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people
BMJ
Vitamin C intake and mortality among a sample of the United States population
Epidemiology
Relation of vitamin C levels to mortality in a geriatric hospital: a study of the effect of vitamin C administration
Age Ageing
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