Does supplemental vitamin C increase cardiovascular disease risk in women with diabetes?

Duk Hee Lee, Aaron R. Folsom, Lisa Harnack, Barry Halliwell, David R. Jacobs

Research output: Contribution to journalArticlepeer-review

157 Scopus citations


Background: Vitamin C acts as a potent antioxidant; however, it can also be a prooxidant and glycate protein under certain circumstances in vitro. These observations led us to hypothesize that a high intake of vitamin C in diabetic persons might promote atherosclerosis. Objective: The objective was to examine the relation between vitamin C intake and mortality from cardiovascular disease. Design: We studied the relation between vitamin C intake and mortality from total cardiovascular disease (n = 281), coronary artery disease (H = 175), and stroke (n = 57) in 1923 postmenopausal women who reported being diabetic at baseline. Diet was assessed with a food-frequency questionnaire at baseline, and subjects initially free of coronary artery disease were prospectively followed for 15 y. Results: After adjustment for cardiovascular disease risk factors, type of diabetes medication used, duration of diabetes, and intakes of folate, vitamin E, and β-carotene, the adjusted relative risks of total cardiovascular disease mortality were 1.0, 0.97, 1.11, 1.47, and 1.84 (P for trend < 0.01) across quintiles of total vitamin C intake from food and supplements. Adjusted relative risks of coronary artery disease were 1.0,0.81,0.99,1.26, and 1.91 (P for trend = 0.01) and of stroke were 1.0, 0.52, 1.23, 2.22, and 2.57 (P for trend < 0.01). When dietary and supplemental vitamin C were analyzed separately, only supplemental vitamin C showed a positive association with mortality endpoints. Vitamin C intake was unrelated to mortality from cardiovascular disease in the nondiabetic subjects at baseline. Conclusion: A high vitamin C intake from supplements is associated with an increased risk of cardiovascular disease mortality in postmenopausal women with diabetes.

Original languageEnglish (US)
Pages (from-to)1194-1200
Number of pages7
JournalAmerican Journal of Clinical Nutrition
Issue number5
StatePublished - Nov 2004


  • Cardiovascular diseases
  • Diabetes mellitus
  • Iron
  • Vitamin C


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