title: Neutrophil superoxide anion--generating capacity, endothelial function and oxidative stress in chronic heart failure: effects of short- and long-term vitamin C therapy.
abstract: OBJECTIVE
  First, we sought to study the effects of short- and long-term vitamin C therapy on oxidative stress and endothelial dysfunction in chronic heart failure (CHF), and second, we sought to investigate the role of neutrophils as a cause of oxidative stress in CHF.
  
  
  BACKGROUND
  Oxidative stress may contribute to endothelial dysfunction in CHF. Vitamin C ameliorates endothelial dysfunction in CHF, presumably by reducing oxidative stress, but this is unproven.
  
  
  METHODS
  We studied 55 patients with CHF (ischemic and nonischemic etiologies) and 15 control subjects. Flow-mediated dilation (FMD) in the brachial artery was measured by ultrasound wall-tracking, neutrophil superoxide anion (O2-) generation by lucigenin-enhanced chemiluminescence and oxidative stress by measurement of free radicals (FRs) in venous blood using electron paramagnetic resonance (EPR) spectroscopy and plasma thiobarbituric acid reactive substances (TBARS). Measurements were performed at baseline in all subjects. The effects of short-term (intravenous) and long-term (oral) vitamin C therapy versus placebo were tested in patients with nonischemic CHF.
  
  
  RESULTS
  At baseline, FRs were higher in patients with CHF than in control subjects (p < 0.01), TBARS were greater (p < 0.005), neutrophil O2- -generating capacity was enhanced (p < 0.005) and FMD was lower (p < 0.0001). Compared with placebo, short-term vitamin C therapy reduced FR levels (p < 0.05), tended to reduce TBARS and increased FMD (p < 0.05), but did not affect neutrophil O2- -generating capacity. Long-term vitamin C therapy reduced FR levels (p < 0.05), reduced TBARS (p < 0.05) and improved FMD (p < 0.05), but also reduced neutrophil O2- -generating capacity (p < 0.05). Endothelial dysfunction was not related to oxidative stress, and improvements in FMD with vitamin C therapy did not relate to reductions in oxidative stress.
  
  
  CONCLUSIONS
  Oxidative stress is increased in ischemic and nonischemic CHF, and neutrophils may be an important cause. Vitamin C reduces oxidative stress, increases FMD and, when given long term, decreases neutrophil O2- generation, but the lack of a correlation between changes in endothelial function and oxidative stress with vitamin C implies possible additional non-antioxidant benefits of vitamin C.
authors.affiliation: Cardiovascular Sciences Research Group, Wales Heart Research Institute, University of Wales College of Medicine, Cardiff, United Kingdom.
authors.forename: G R
authors.initials: GR
authors.lastname: Ellis
authors.forename: R A
authors.initials: RA
authors.lastname: Anderson
authors.forename: D
authors.initials: D
authors.lastname: Lang
authors.forename: D J
authors.initials: DJ
authors.lastname: Blackman
authors.forename: R H
authors.initials: RH
authors.lastname: Morris
authors.forename: J
authors.initials: J
authors.lastname: Morris-Thurgood
authors.forename: I F
authors.initials: IF
authors.lastname: McDowell
authors.forename: S K
authors.initials: SK
authors.lastname: Jackson
authors.forename: M J
authors.initials: MJ
authors.lastname: Lewis
authors.forename: M P
authors.initials: MP
authors.lastname: Frenneaux
mesh_terms: D000838:Anions; D001205:Ascorbic Acid / Q000627:therapeutic use*; D002908:Chronic Disease; D004727:Endothelium / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009504:Neutrophils / Q000187:drug effects / Q000378:metabolism*; D018384:Oxidative Stress / Q000187:drug effects; D013481:Superoxides / Q000378:metabolism*; D013997:Time Factors
chemical_list: D000838:Anions; D013481:Superoxides; D001205:Ascorbic Acid