Vitamin C and Reperfusion Injury: Simple and Inexpensive Cardiac Intervention
Review by: Paul Anderson, NMD
Title: Vitamin C and Reperfusion Injury: Simple and Inexpensive Cardiac Intervention
Reference: Valls N, et al. Amelioration of persistent left ventricular function impairment through increased plasma ascorbate levels following myocardial infarction. Redox Rep. 2016. PMID 26066587
Design: Human interventional trial
Practice Implications: Vitamin C is seemingly so ubiquitous an intervention in integrative healthcare that it is easy to overlook its potential therapeutic benefit as well as economical cost profile when considering therapies. One therapeutic target that is both common and also often filled with costly interventions is cardiovascular prevention and disease. All the common natural interventions are necessary and generally worth the cost. This paper and the others noted below reminded me of the profound benefit that vitamin C can add to cardiovascular prevention and therapy.
In this study the authors set up the intervention with the following description:
“Percutaneous coronary angioplasty (PCA) has been demonstrated to reduce mortality and morbidity and thereby improve the prognosis of patients undergoing acute myocardial infarctions (AMIs). However, this procedure paradoxically increases the initial damage as the result of a condition known as ‘myocardial reperfusion injury’. Oxidative stress may contribute to the mechanism of this injury. The goal of the present study was to ascertain whether high plasma ascorbate levels could ameliorate the reperfusion injuries that occur after the successful restoration of blood flow.”
As a model of cardiovascular disease for AMIs, PCA and reperfusion injury are both easily studied and serve as an excellent set of markers for general cardiovascular effect of an intervention. In this study, the simple and inexpensive intervention (vitamin C) showed objective improvement in these parameters when low ascorbate versus high ascorbate levels were compared: “These data are consistent with the protective effect of high plasma levels of ascorbate against the oxidative challenge caused by reperfusion injury in patients subjected to PCA following an AMI.”
What was the intervention to gain the therapeutic benefit? An initial loading dose of vitamin C using an infusion was followed by oral treatment with vitamin C (500 mg/12 hours) plus vitamin E (400 IU/day) for 84 days. Obviously the tocopherol is synergistic with the vitamin C [see referenced newsletter 1] but the fact that the measured parameter of high versus low plasma ascorbate showed correlation to clinical effect supports vitamin C as a beneficial intervention.
A logical question is “the intervention started with an infusion of vitamin C, can we gain these benefits with oral dosing alone?” This question came to me as I read the study and can be simply answered. There is the chance that in the acute setting (such as was used for this trial) that an immediate infusion of vitamin C could add some benefit as a loading dose. That cannot be excluded as a possibility. In terms of pathology and definitely in terms of prevention, oral vitamin C is sufficient to keep plasma levels in these ranges. The intervention dose of 500 mg every 12 hours was certainly conservative and very achievable in almost any patient setting. As mentioned, the addition of tocopherols at low doses is appropriate as a synergist.
Can vitamin C aid cardiovascular health in other ways? There are many mechanisms by which maintaining these plasma levels of vitamin C can be beneficial. For example, in cell studies of platelet activation modulation, vitamin C has been shown to decrease platelet adhesion, another trigger of cardiovascular pathology. 
Clinical Tips: In clinical practice, I employ this information in the following manner (all include normal healthy diet, lifestyle and nutrient basics):
Vitamin C 500 to 1500 mg twice a day with food
Vitamin E (as mixed Tocopherols 400 IU or Tocotrienols at 150-300 mg) once a day
Therapeutic use before and after cardiovascular events or procedures:
Vitamin C 1000 to 1500 mg three times a day with food
Vitamin E (as mixed Tocopherols 400 IU or Tocotrienols at 150-300 mg) twice a day
Note: This therapeutic use is intended for up to eight weeks prior to (if possible) and twelve weeks following the procedure or event. Then preventive doses can be used. Also if using these doses prior to an interventional procedure (stent placement, surgery etc.), these nutrients should be discontinued five to seven days prior to the procedure and re-started as soon after the procedure as possible.
While there are many excellent supplements to employ in the care and prevention of cardiovascular disease, it is good to be reminded that from both a basic science perspective as well as a human clinical research basis, that simple and low cost interventions such as vitamin C can be so powerful. It is also helpful to have a low cost base intervention to use in the setting of those with low income and resources to deploy in their healthcare.
- See the Emerson Newsletter: 02-15-2015 – Author: Paul Anderson, ND – Title: “ReDox” –Our ever evolving understanding of oxidative balance, kinetics and implications in health and disease.
- Secor D, et al. Ascorbate inhibits platelet-endothelial adhesion in an in-vitro model of sepsis via reduced endothelial surface P-selectin expression. Blood Coagul Fibrinolysis. 2016. PMID 26829365
 Secor D, et al. Ascorbate inhibits platelet-endothelial adhesion in an in-vitro model of sepsis via reduced endothelial surface P-selectin expression. Blood Coagul Fibrinolysis. 2016.