Acute vitamin C improves cardiac function, not exercise capacity, in adults with type 2 diabetes

Rebecca L Scalzo, Timothy A Bauer, Kylie Harrall, Kerrie Moreau, Cemal Ozemek, Leah Herlache, Shawna McMillin, Amy G Huebschmann, Jennifer Dorosz, Jane E B Reusch, Judith G Regensteiner, Rebecca L Scalzo, Timothy A Bauer, Kylie Harrall, Kerrie Moreau, Cemal Ozemek, Leah Herlache, Shawna McMillin, Amy G Huebschmann, Jennifer Dorosz, Jane E B Reusch, Judith G Regensteiner

Abstract

Background: People with type 2 diabetes (T2D) have impaired exercise capacity, even in the absence of complications, which is predictive of their increased cardiovascular mortality. Cardiovascular dysfunction is one potential cause of this exercise defect. Acute infusion of vitamin C has been separately shown to improve diastolic and endothelial function in prior studies. We hypothesized that acute vitamin C infusion would improve exercise capacity and that these improvements would be associated with improved cardiovascular function.

Methods: Adults with T2D (n = 31, 7 female, 24 male, body mass index (BMI): 31.5 ± 0.8 kg/m2) and BMI-similar healthy adults (n = 21, 11 female, 10 male, BMI: 30.4 ± 0.7 kg/m2) completed two randomly ordered visits: IV infusion of vitamin C (7.5 g) and a volume-matched saline infusion. During each visit peak oxygen uptake (VO2peak), brachial artery flow mediated dilation (FMD), reactive hyperemia (RH; plethysmography), and cardiac echocardiography were measured. General linear mixed models were utilized to assess the differences in all study variables.

Results: Acute vitamin C infusion improved diastolic function, assessed by lateral and septal E:E' (P < 0.01), but did not change RH (P = 0.92), or VO2peak (P = 0.33) in any participants.

Conclusion: Acute vitamin C infusion improved diastolic function but did not change FMD, forearm reactive hyperemia, or peak exercise capacity. Future studies should further clarify the role of endothelial function as well as other possible physiological causes of exercise impairment in order to provide potential therapeutic targets.Trial registration NCT00786019. Prospectively registered May 2008.

Keywords: Brachial artery flow mediated dilation; Cardiac echocardiography; Cardiorespiratory fitness; Oxygen uptake kinetics.

Figures

Fig. 1
Fig. 1
Study protocol overview
Fig. 2
Fig. 2
Vascular function saline and during an acute vitamin C infusion. a Brachial artery flow mediated dilation (FMD). b Reactive hyperemia in forearm
Fig. 3
Fig. 3
The effect of acute, peak exercise on systolic and diastolic function saline and during an acute vitamin C infusion. Data in panels a–d are presented as the change (Δ) from rest/pre-infusion to peak exercise. a Change in lateral E:E’. b Change in septal E:E’. c Change in mitral valve deceleration time. d Change in ejection fraction from rest/pre-infusion to peak exercise. e Left ventricular circumferential strain measured at peak exercise. f Left ventricular longitudinal strain measured at peak exercise. *Significantly different from saline (P < 0.01). †Significant interaction between the vitamin C intervention and group (P = 0.018); mitral valve deceleration time decreased in participants with T2D with vitamin C. There was a suggestive change in ejection fraction with acute, peak exercise during vitamin C infusion (P = 0.057). There was a suggestive decrease in the peak exercise circumferential strain with during vitamin C infusion (P = 0.052)

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