Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people

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Abstract
Objectives: To determine whether vitamin C status, as measured by dietary intake and plasma ascorbic acid concentration, is related to mortality from stroke and coronary heart disease in people aged 65 and over. Design: A 20 year follow up study of a cohort of randomly selected elderly people living in the community who had taken part in the 1973-4 Department of Health and Social Security nutritional survey and for whom dietary and other data had been recorded. Setting: Eight areas in Britain (five in England, two in Scotland, and one in Wales). Subjects: 730 men and women who had completed a seven day dietary record and who had no history or symptoms of stroke, cerebral arteriosclerosis, or coronary heart disease when examined by a geriatrician in 1973-4. Results: Mortality from stroke was highest in those with the lowest vitamin C status. Those in the highest third of the distribution of vitamin C intake had a relative risk of 0.5 (95% confidence interval 0.3 to 0.8) compared with those in the lowest third, after adjustment for age, sex, and established cardiovascular risk factors. The relation between vitamin C intake and stroke was independent of social class and other dietary variables. A similar gradient in risk was present for plasma ascorbic acid concentrations. No association was found between vitamin C status and risk of death from coronary heart disease. Conclusion: In elderly people vitamin C concentration, whether measured by dietary intake or plasma concentration of ascorbic acid, is strongly related to subsequent risk of death from stroke but not from coronary heart disease. Key messages Vitamin C is the most important dietary antioxidant in terms of intake Both dietary intake of vitamin C and plasma ascorbate concentrations were related to risk of death from stroke (but not from coronary heart disease) in 730 elderly people studied prospectively Vitamin C status was as strong a predictor of death from stroke as diastolic blood pressure Antioxidant vitamins are potentially important in the prevention of cerebrovascular disease