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Effect of vitamin C on endothelial function in health and disease: a systematic review and meta-analysis of randomised controlled trials.

AbstractBACKGROUND:
Observational studies indicate that higher vitamin C intake is associated with reduced risk for cardiovascular diseases. However, randomised controlled trials (RCT) examining the effect of vitamin C on endothelial function (EF) have reported inconsistent results. The aims of this systematic review and meta-analysis were to determine the effect of vitamin C supplementation on EF and to investigate whether the effect was influenced by health status, study duration, dose and route of vitamin C administration.
METHODS:
We searched the Medline, Embase, Cochrane Library, and Scopus databases from inception to May 2013 for studies that met the following criteria: 1) RCT with adult participants, 2) vitamin C administered alone, 3) studies that quantified EF using commonly applied methods including ultrasound, plethysmography and pulse wave analysis.
RESULTS:
Pooling the data from 44 clinical trials showed a significant positive effect of vitamin C on EF (SMD: 0.50, 95% CI: 0.34, 0.66, P < 0.001). Stratification of the analysis by health outcome revealed improved EF in atherosclerotic (SMD: 0.84, 95% CI: 0.41, 1.26, P < 0.001), diabetic (SMD: 0.52, 95% CI: 0.21, 0.82, P < 0.001) and heart failure patients (SMD: 0.48, 95% CI: 0.08, 0.88, P < 0.02) after vitamin C supplementation. The effect size appeared to be unaffected by study design, duration, baseline plasma vitamin C concentration or route of administration of vitamin C. The meta-regression showed a significant positive association between vitamin C dose and improvement in EF (β: 0.00011, 95% CI: 0.00001, 0.00021, P = 0.03).
CONCLUSIONS:
Vitamin C supplementation improved EF. The effect of vitamin C supplementation appeared to be dependent on health status, with stronger effects in those at higher cardiovascular disease risk. PROSPERO Database registration: CRD42013004567, http://www.crd.york.ac.uk/prospero/
AuthorsAmmar W Ashor, Jose Lara, John C Mathers, Mario Siervo
JournalAtherosclerosis (Atherosclerosis) Vol. 235 Issue 1 Pg. 9-20 (Jul 2014) ISSN: 1879-1484 [Electronic] Ireland
PMID24792921 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
CopyrightCopyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Chemical References
  • Antioxidants
  • Ascorbic Acid
Topics
  • Adult
  • Aged
  • Antioxidants (administration & dosage)
  • Ascorbic Acid (administration & dosage, therapeutic use)
  • Atherosclerosis
  • Cardiovascular Diseases (prevention & control, therapy)
  • Dietary Supplements
  • Endothelium (drug effects)
  • Female
  • Healthy Volunteers
  • Humans
  • Inflammation
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Regression Analysis
  • Young Adult

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