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Address correspondence to this author at the Health Women's Heart Center, Preventive Cardiac Center, Medicine Cedars-Sinai Heart Institute 444 S San Vicente Blvd, Suite 600, Los Angeles, CA90048, USA; Tel: 310-423-9680; Fax: 310-423-9681; E-mail: merz@cshs.org

The authors confirm that this article content has no conflicts of interest.



  • Ascorbic acid
  • atherosclerosis
  • cardiovascular disease.
  • vitamin C

Differing relations to early atherosclerosis between vitamin C from supplements vs. food in the Los Angeles atherosclerosis study: A Prospective Cohort Study


Journal Title:

Open Cardiovascular Medicine Journal


Volume 6, Number 1


, Pages 113-121

Type of Work:

Article | Final Publisher PDF


Objective: To determine the relationship of vitamin c intake from supplements vs food on early atherosclerosis detected by carotid intima media thickness (IMT). Background: Oxidative stress and endothelial dysfunction play a critical role in the pathogenesis of atherosclerosis. Die-tary vitamin C appears to have anti-oxidant properties and beneficial relations to endothelial function, yet vitamin C taken as a vitamin supplement does not appear to protect from cardiovascular events. The impact of vitamin c intake from sup-plements vs food on progression of atherosclerosis is unknown. Methods: We examined 3-year progression of carotid IMT in a randomly sampled cohort of 573 healthy women and men aged 40-60 years. Progression of carotid IMT was determined bilaterally with B-mode ultrasound at 3 examinations (1.5-year intervals). Intake of dietary vitamin C was measured by six, 24-hour recall interviews. Intake of vitamin C from vi-tamin supplements was measured by questionnaire in quartiles of supplement intake and no supplement. Vitamin C was-measured in plasma as ascorbic acid. Results: Carotid IMT progressed 10.0±16.5 μm/year (mean±SD) among all those with follow-up (n=500; 87%). For those who took vitamin C supplements, carotid IMT progression increased with dose (p-trend=0.0009). Among persons in the highest quartile (857-5000 mg/day) of vitamin C supplement intake compared to those not consuming any vitamin C sup-plements, carotid IMT progression increased three-fold (20.3±2.6 versus 7.6±1.8 μm/year (mean±SD); p<0.001). The ad-verse association of vitamin C supplement intake with carotid IMT was two-fold greater in the upper tertile of serum cho-lesterol compared to the lower two tertiles (p=0.01). In contrast to the adverse association of vitamin C supplements, vi-tamin C intake from food had a weak protective relationship on carotid IMT progression (reduced progression -5.0±1.9 μm/year; p=0.008). Conclusions: Vitamin C supplementation is associated with accelerated early atherosclerosis measured by carotid IMT compared to a protective association with vitamin C from food. Theadverse association of vitamin C supplementation may be greater in patients with higher serum cholesterol levels. The current results provide a potential mechanistic understand-ing for the observed differences between Vitamin C in supplements vs food in prior studies. Given these observa-tions,vitamin C supplementation does not appear to be currently advisable for prevention or treatment of atherosclerosis.

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© Agarwal et al.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/).

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