Serum vitamin C concentration is low in peripheral arterial disease and is associated with inflammation and severity of atherosclerosis

Circulation. 2001 Apr 10;103(14):1863-8. doi: 10.1161/01.cir.103.14.1863.


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 micromol/L) despite comparable smoking status and dietary intake with the other groups (P<0.0001). Subclinical vitamin C deficiency (<11.4 micromol/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.

MeSH terms

  • Aged
  • Arteriosclerosis / blood*
  • Arteriosclerosis / pathology
  • Ascorbic Acid / blood*
  • Aspirin / pharmacology
  • C-Reactive Protein / drug effects
  • C-Reactive Protein / metabolism
  • Female
  • Fibrinogen / drug effects
  • Fibrinogen / metabolism
  • Humans
  • Hypertension / blood
  • Inflammation / blood*
  • Lipids / blood
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Peripheral Vascular Diseases / blood*
  • Peripheral Vascular Diseases / pathology
  • Severity of Illness Index
  • Smoking


  • Lipids
  • Fibrinogen
  • C-Reactive Protein
  • Ascorbic Acid
  • Aspirin