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(Circulation. 2001;103:1863.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Serum Vitamin C Concentration Is Low in Peripheral Arterial Disease and Is Associated With Inflammation and Severity of Atherosclerosis

Michel Langlois, MD, PhD; Daniel Duprez, MD, PhD; Joris Delanghe, MD, PhD; Marc De Buyzere, PhD; Denis L. Clement, MD, PhD

From the Departments of Clinical Chemistry (M.L., J.D.) and Cardiology (D.D., M.D.B., D.L.C.), Ghent University Hospital, Ghent, Belgium.

Correspondence to Dr Michel Langlois, Laboratory of Clinical Chemistry, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail michel.langlois{at}rug.ac.be

Background—Peripheral arterial disease (PAD) is a severe atherosclerotic condition frequently accompanied by inflammation and oxidative stress. We hypothesized that vitamin C antioxidant levels might be low in PAD and are related to inflammation and disease severity.

Methods and Results—We investigated vitamin C (L-ascorbic acid) levels in 85 PAD patients, 106 hypertensives without PAD, and 113 healthy subjects. Serum L-ascorbic acid concentrations were low among PAD patients (median, 27.8 µmol/L) despite comparable smoking status and dietary intake with the other groups (P<0.0001). Subclinical vitamin C deficiency (<11.4 µmol/L), confirmed by low serum alkaline phosphatase activity, was found in 14% of the PAD patients but not in the other groups. Serum C-reactive protein (CRP) concentrations were significantly higher in PAD patients (P<0.0001) and negatively correlated with L-ascorbic acid levels (r=-0.742, P<0.0001). In stepwise multivariate analysis, low L-ascorbic acid concentration in PAD patients was associated with high CRP level (P=0.0001), smoking (P=0.0009), and shorter absolute claudication distance on a standardized graded treadmill test (P=0.029).

Conclusions—Vitamin C concentrations are lower in intermittent claudicant patients in association with higher CRP levels and severity of PAD. Future studies attempting to relate vitamin C levels to disease occurrence should include in their analysis an inflammatory marker such as CRP.

Key Words: arteries • atherosclerosis • antioxidants • inflammation • claudication

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