This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kurl, S. Articles by Salonen, J.T. Search for Related Content PubMed PubMed Citation Articles by Kurl, S. Articles by Salonen, J.T. Related Collections Nutrition Epidemiology Cerebrovascular disease/stroke Risk Factors for Stroke

(Stroke. 2002;33:1568.)
© 2002 American Heart Association, Inc.

Original Contributions

Plasma Vitamin C Modifies the Association Between Hypertension and Risk of Stroke

S. Kurl, MD; T.P. Tuomainen, MD; J.A. Laukkanen, MD; K. Nyyssönen, PhD; T. Lakka, MD, PhD; J. Sivenius, MD, PhD J.T. Salonen, MD, PhD, MscPH

From the Research Institute of Public Health (S.K., T.P.T., J.A.L., K.N., T.L., J.T.S.), Department of Community Health and General Practice and Inner Savo Health Centre (J.T.S.), and Department of Neuroscience and Neurology and Brain Research and Rehabilitation Centre Neuron (J.S.), University of Kuopio, Kuopio, Finland.

Correspondence to Professor J.T. Salonen, Research Institute of Public Health, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland. E-mail jukka.salonen{at}uku.fi

Background and Purpose— There are no prospective studies to determine whether plasma vitamin C modifies the risk of stroke among hypertensive and overweight individuals. We sought to examine whether plasma vitamin C modifies the association between overweight and hypertension and the risk of stroke in middle-aged men from eastern Finland.

Methods— We conducted a 10.4-year prospective population-based cohort study of 2419 randomly selected middle-aged men (42 to 60 years) with no history of stroke at baseline examination. A total of 120 men developed a stroke, of which 96 were ischemic and 24 hemorrhagic strokes.

Results— Men with the lowest levels of plasma vitamin C (<28.4 µmol/L, lowest quarter) had a 2.4-fold (95% CI, 1.4 to 4.3; P=0.002) risk of any stroke compared with men with highest levels of plasma vitamin C (>64.96 µmol/L, highest quarter) after adjustment for age and examination months. An additional adjustment for body mass index, systolic blood pressure, smoking, alcohol consumption, serum total cholesterol, diabetes, and exercise-induced myocardial ischemia attenuated the association marginally (relative risk, 2.1; 95% CI, 1.2 to 3.8; P=0.01). Adjustment for prevalent coronary heart disease and atrial fibrillation did not attenuate the association any further. Furthermore, hypertensive men with the lowest vitamin C levels (<28.4 µmol/L) had a 2.6-fold risk (95% CI, 1.52 to 4.48; P<0.001), and overweight men (25 kg/m²) with low plasma vitamin C had a 2.7-fold risk (95% CI, 1.48 to 4.90; P=0.001) for any stroke after adjustment for age, examination months, and other risk factors.

Conclusions— Low plasma vitamin C was associated with increased risk of stroke, especially among hypertensive and overweight men.

Key Words: ascorbic acid • hypertension • obesity • preventive medicine • risk • stroke

This article has been cited by other articles:

				T. Tynes and T. Haldorsen Mortality in the Sami population of North Norway, 1970 98 Scand J Public Health, May 1, 2007; 35(3): 306 - 312. [Abstract] [PDF]

				S. Kurl, J. A. Laukkanen, L. Niskanen, D. Laaksonen, J. Sivenius, K. Nyyssonen, and J. T. Salonen Metabolic Syndrome and the Risk of Stroke in Middle-Aged Men Stroke, March 1, 2006; 37(3): 806 - 811. [Abstract] [Full Text] [PDF]

				J. A. Simon, M. A. Murtaugh, M. D. Gross, C. M. Loria, S. B. Hulley, and D. R. Jacobs Jr. Relation of Ascorbic Acid to Coronary Artery Calcium: The Coronary Artery Risk Development in Young Adults Study Am. J. Epidemiol., March 15, 2004; 159(6): 581 - 588. [Abstract] [Full Text] [PDF]

				K. W. Lee, H. J. Lee, Y.-J. Surh, and C. Y. Lee Vitamin C and cancer chemoprevention: reappraisal Am. J. Clinical Nutrition, December 1, 2003; 78(6): 1074 - 1078. [Abstract] [Full Text] [PDF]

				C. Sauvaget, J. Nagano, N. Allen, and K. Kodama Vegetable and Fruit Intake and Stroke Mortality in the Hiroshima/Nagasaki Life Span Study Stroke, October 1, 2003; 34(10): 2355 - 2360. [Abstract] [Full Text] [PDF]

				T. Matsumoto, L. V. d'uscio, D. Eguchi, M. Akiyama, L. A. Smith, and Z. S. Katusic Protective Effect of Chronic Vitamin C Treatment on Endothelial Function of Apolipoprotein E-Deficient Mouse Carotid Artery J. Pharmacol. Exp. Ther., July 1, 2003; 306(1): 103 - 108. [Abstract] [Full Text] [PDF]

				L. V. d'Uscio, S. Milstien, D. Richardson, L. Smith, and Z. S. Katusic Long-Term Vitamin C Treatment Increases Vascular Tetrahydrobiopterin Levels and Nitric Oxide Synthase Activity Circ. Res., January 10, 2003; 92(1): 88 - 95. [Abstract] [Full Text] [PDF]