Background: Vitamin C is related to lower levels of high-sensitivity C-reactive protein (hsCRP), an inflammatory biomarker that predicts cardiovascular disease. Whether vitamin C deficiency is associated with hsCRP and cardiac events in heart failure (HF) patients has not been examined. Purpose: The aim of this study is to determine the relationships among vitamin C intake, serum levels of hsCRP, and cardiac events. Methods: A total of 200 HF patients completed a 3-day food diary to determine vitamin C deficiency and provided blood to measure serum levels of hsCRP. Patients were followed for 2 years to obtain data on cardiac event-free survival. Moderation analyses with hierarchical logistic and Cox regressions were used for the data analysis. Results: Seventy-eight patients (39%) had vitamin C deficiency and 100 (50%) had an hsCRP level higher than 3 mg/L. Vitamin C deficiency was associated with an hsCRP level higher than 3 mg/L in the hierarchical logistic regression (odds ratio, 2.40; 95% confidence interval, [1.13-5.10]; P =.023). Vitamin C deficiency (hazard ratio, 1.68; 95% CI, 1.05-2.69, P =.029) and hsCRP level higher than 3 mg/L (hazard ratio, 1.79; 95% CI, 1.07-3.01; P =.027) predicted shorter cardiac event-free survival in hierarchical Cox regression. The interaction of hsCRP level higher than 3 mg/L and vitamin C deficiency produced a 2.3-fold higher risk for cardiac events (P =.002) in moderation analysis. Higher level of hsCRP predicted shorter cardiac event-free survival only in patients with vitamin C deficiency (P =.027), but not in those with vitamin C adequacy. Conclusion: Vitamin C deficiency moderated the relationship between inflammation and cardiac events in patients with HF. Future study is required to determine whether adequate intake of vitamin C could play a protective role against the impact of inflammation on cardiac events in HF patients.
Bibliographical noteFunding Information:
Associate Professor, Department of Nursing, College of Medicine, University of Ulsan, Korea. Seok-Min Kang, MD, PhD Professor, Division of Cardiology, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Severance Hospital, Seoul, Korea. This work was supported by a grant, NRF-2015R1D1A1A01059392, from the National Research Foundation of Korea. The authors have no conflicts of interest to disclose. Correspondence Eun Kyeung Song, PhD, RN, Department of Nursing, College of Medicine, University of Ulsan, Daehak-ro 93, Nam-gu, Ulsan, South Korea, 680-749 (email@example.com).
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
- Advanced and Specialised Nursing