Improvement of sympathetic response to exercise by oral administration of ascorbic acid in patients after myocardial infarction.
BACKGROUND
Recent studies indicated that excessive oxidative stress in an animal heart failure model injures both the sympathetic nerve endings and receptors, resulting in disturbance of norepinephrine release and sensitivity to norepinephrine. However, it has not been clarified whether this phenomenon is expressed clinically in patients with heart disease. Therefore, we examined the efficacy of ascorbic acid administration as an antioxidant vitamin in relation to the heart rate and norepinephrine response to exercise in patients after myocardial infarction.


METHODS
In this randomized crossover trial, 21 male patients who had had myocardial infarction underwent symptom-limited ergometer cardiopulmonary exercise testing twice, that is, without and with ascorbic acid (2 g) administration. Plasma norepinephrine concentrations were assessed at rest and at peak exercise, and heart rate responsiveness to the norepinephrine increment from rest to peak exercise (DeltaHR/logDeltaNE) was calculated.


RESULTS
In the exercise test after ascorbic acid administration, peak oxygen consumption (VO(2)) improved over baseline. Ascorbic acid administration significantly increased the change in heart rate and norepinephrine from rest to peak exercise and DeltaHR/logDeltaNE. The increment in heart rate was significantly correlated with peak VO(2) in each test.


CONCLUSIONS
Ascorbic acid intake before exercise improved exercise capacity through enhancement of the heart rate and norepinephrine response to exercise in patients after myocardial infarction. These findings suggest that ascorbic acid intake improves sympathetic dysfunction resulting from injury by excessive oxidative stress after myocardial infarction.
Kato
Kazuyo
K
The First Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. s3088@nms.ac.jp
Fukuma
Nagaharu
N
Kimura-Kato
Yuko
Y
Aisu
Noriko
N
Tuchida
Takaya
T
Mabuchi
Kousuke
K
Takano
Teruo
T
D000368:Aged; D001205:Ascorbic Acid / Q000097:blood / Q000627:therapeutic use*; D018592:Cross-Over Studies; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D009638:Norepinephrine / Q000097:blood / Q000494:pharmacology; D010101:Oxygen Consumption / Q000187:drug effects; D012146:Rest; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology
D001205:Ascorbic Acid; D009638:Norepinephrine