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Vitamin C prevents endothelial dysfunction induced by acute exercise in patients with intermittent claudication
Abstract
In patients with intermittent claudication, exercise is associated with a marked increase in oxidative stress, likely responsible for systemic endothelial perturbation. In 31 claudicant patients, we assessed the effect of vitamin C administration on the acute changes induced by maximal and submaximal exercise in endothelium-dependent, flow-mediated dilation (FMD), and in plasma levels of thiobarbituric acid-reactive substances (TBARS) and soluble intercellular adhesion molecule-1 (sICAM-1). In 16 claudicants, maximal exercise reduced FMD (from 8.5+/-0.9 to 3.7+/-0.8%, P<0.01), and increased plasma levels of TBARS (from 1.93+/-0.06 to 2.22+/-0.1 nmol/ml, P<0.02) and of sICAM-1 (from 282+/-17 to 323+/-19 ng/ml, P<0.01). In eight of these patients, randomized to vitamin C, exercise-induced changes in FMD and biochemistry were abolished. This beneficial effect was not observed in the eight patients randomized to saline. In 15 patients, who walked until the onset of claudication pain (submaximal exercise), and in ten control subjects, who performed maximal exercise, no changes were observed with exercise. Thus, in claudicants, vitamin C prevents the acute, systemic impairment in endothelial function induced by maximal exercise. This finding provides a rationale for trials investigating antioxidant therapy and cardiovascular risk in patients with intermittent claudication.
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“superoxide radicals produced as a consequence of intense exercise may directly remove NO (Li and Forstermann 2000; Silvestro et al. 2002).”
From Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure (2016) · cites this paper as Silvestro et al. 2002
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Currie, K. D., McKelvie, R. S., & MacDonald, M. J. (2012) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318260ff92 · Cited by 82
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“However, observations indicate that augmented oxidative stress is abolished when vitamin C is given prior to several different types of interventions [37-39].”
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Johnson, B. D., Mather, K. J., Newcomer, S. C., Mickleborough, T. D., & Wallace, J. P. (2012) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2012-0169 · Cited by 34
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“Electron spin resonance studies have shown that vitamin C administration decreased the levels of free radicals generated during exercise [14,15] and vitamin C administration attenuated the increases in oxidative stress markers caused by exercise [16-18].”
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“4,5 Free radicals impair vasodilation, 6,7 and may contribute to claudication pain.”
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“studies showing that, in LE-PAD patients, ischemic exercise promotes neutrophil activation and is associated with increased endothelial permeability at distant sites [27–31].”
BackgroundHaro, J. D., Acín, F., López-Quintana, A., Medina, F. J., Martínez-Aguilar, E., Florez, A., & March, J. R. (2008) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2007.10.016 · Cited by 29
Tymko, M. M., Tremblay, J. C., Hansen, A. B., Howe, C. A., Willie, C. K., Stembridge, M. R., GREEN, D. J., Hoiland, R. L., Subedi, P., Anholm, J. D., et al. (2016) · The Journal of Physiology · doi:10.1113/jp273183 · Cited by 28
Oxidative damage to skeletal muscle following an acute bout of contractile claudication
Judge, A. R., & DODD, S. L. (2003) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2003.08.022 · Cited by 28
“[5] showed an increase in lipid peroxidation following maximal but not submaximal exercise.”
BackgroundJoras, M., & Poredoš, P. (2008) · Vascular Medicine · doi:10.1177/1358863x08096347 · Cited by 27
Shahin, Y., Cockcroft, J. R., & Chetter, I. C. (2013) · British journal of surgery · doi:10.1002/bjs.9198 · Cited by 26
Thomas, K. N., Cotter, J. D., Williams, M. J. A., & van Rij, A. M. (2016) · Vascular and Endovascular Surgery · doi:10.1177/1538574416639150 · Cited by 25
Use of hyperspectral imaging to assess endothelial dysfunction in peripheral arterial disease
Sumpio, B. J., Citoni, G., Chin, J. A., & Sumpio, B. E. (2016) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2016.03.463 · Cited by 25
Gardner, A. W., Montgomery, P. S., Zhao, Y. D., Silva-Palacios, F., Ungvari, Z. I., Csiszár, A., & Sonntag, W. E. (2017) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2016.12.108 · Cited by 25
Gresele, P., Migliacci, R., Arosio, E., Bonizzoni, E., Minuz, P., & Violi, F. (2012) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2012.05.064 · Cited by 25
Lehr, H., Germann, G., McGregor, G. P., Migeod, F., Roesen, P., Tanaka, H., Uhlig, C., & Biesalski, H. K. (2006) · PubMed · Cited by 25
da Silva, N. D., Roseguini, B. T., Chehuen, M. D. R., Fernandes, T. M., da Mota, G. D. F. A., Martin, P. K. M., Han, S. W., Forjaz, C. L. M., Wolosker, N., & de Oliveira, E. M. (2015) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00158.2015 · Cited by 23
“Among other consequences, repeated exposure to these injurious events is thought to promote functional and structural abnormalities in skeletal muscle (13, 24, 44) and endothelial dysfunction (57).”
Silvestro, A., Schiano, V., Bucur, R., Brevetti, G., Scopacasa, F., & Massimo Chiariello, A. (2006) · Angiology · doi:10.1177/000331970605700203 · Cited by 23
Self-citationCarter, S. E., Faulkner, A., & Rakobowchuk, M. (2013) · Journal of Hypertension · doi:10.1097/hjh.0000000000000033 · Cited by 22
“Acute intra-arterial infusion of vitamin C decreases endothelial dysfunction in healthy individuals and peripheral artery disease patients [11] and attenuates the reduction in FMD following ischemia–reperfusion injury induced by exercise in patients with intermittent claudication [10].”
BackgroundInfluentialKals, J., Kampus, P., Kals, M., Pulges, A., Teesalu, R., & Zilmer, M. (2005) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2005.06.014 · Cited by 22
Lyall, G. K., Davies, M. J., Ferguson, C., Porter, K. E., & Birch, K. M. (2019) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00156.2019 · Cited by 21
Roseguini, B. T., Hirai, D. M., Alencar, M. C. N., Ramos, R. P., Silva, B. M., Wolosker, N., Neder, J. A., & Nery, L. E. (2014) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00183.2014 · Cited by 21
“Exercise-induced muscle ischemia in patients with IC evokes a potent increase in local and systemic markers of inflammation and oxidative stress (33, 47, 56), as well as an acute impairment in vascular reactivity (48).”
BackgroundEndothelial dysfunction in patients with Buerger disease
Igari, K., Kudo, T., Toyofuku, T., & Inoue, Y. (2017) · Vascular Health and Risk Management · doi:10.2147/vhrm.s139892 · Cited by 21
“Some authors have reported the association between the endothelial dysfunction measured using the FMD test and the ABI.”
Komai, H., Higami, Y., Tanaka, H., Honda, K., Juri, M., & Okamura, Y. (2008) · Angiology · doi:10.1177/0003319707303442 · Cited by 21
Andrade-Lima, A., Miranda, A. S., Correia, M. D. A., Germano-Soares, A. H., Cucato, G. G., Filho, D. C. S., Gomes, S. L., & Ritti‐Dias, R. M. (2015) · Journal of Vascular Nursing · doi:10.1016/j.jvn.2015.09.001 · Cited by 19
Does nutrition have a role in peripheral vascular disease?
Carrero, J. J., & Grimble, R. F. (2006) · British Journal Of Nutrition · doi:10.1079/bjn20051616 · Cited by 19
“A small study showed that vitamin C prevented endothelial function induced by exercise in PVD patients with IC, together with a decrease in thiobarbituric acid reactive substance and soluble intracellular adhesion molecule-1 levels (Silvestro et al. 2002).”
Andrade-Lima, A., Correia, M. D. A., Germano-Soares, A. H., Farah, B. Q., Forjaz, C. L. M., Silva, A. S., Brasileiro‐Santos, M. S., dos Santos, A. C., & Ritti‐Dias, R. M. (2016) · Clinical Physiology and Functional Imaging · doi:10.1111/cpf.12384 · Cited by 21
“…peripheral sympathetic nerve activity (Halliwill et al., 1996; Bisquolo et al., 2005) and depresses the vasoconstrictive response to sympathetic stimuli (Halliwill et al., 1996), and walking at submaximal intensity did not produce endothelial injury in patients with PAD (Silvestro et al., 2002).”
BackgroundResultInfluentialYan, J., Tie, G., & Messina, L. M. (2012) · Molecular Medicine · doi:10.2119/molmed.2011.00103 · Cited by 19
Currie, K. D., McKelvie, R. S., & MacDonald, M. J. (2014) · BioMed Research International · doi:10.1155/2014/591918 · Cited by 18
“Endothelial-independent function was assessed using a 0.4mg dose of nitroglycerin (NTG).”
MethodVascular Nitric Oxide–Superoxide Balance and Thrombus Formation after Acute Exercise
Przyborowski, K., Proniewski, B., Czarny, J., Smęda, M., SITEK, B., Zakrzewska, A., Zoladz, J. A., & Chłopicki, S. (2018) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001589 · Cited by 18
Tymko, M. M., Tremblay, J. C., Steinback, C. D., Moore, J. P., Hansen, A. B., Patrician, A., Howe, C. A., Hoiland, R. L., GREEN, D. J., & Ainslie, P. N. (2017) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00583.2017 · Cited by 18
Antioxidants attenuate oxidative damage in rat skeletal muscle during mild ischaemia
Judge, A. R., Selsby, J. T., & DODD, S. L. (2008) · Experimental Physiology · doi:10.1113/expphysiol.2007.040972 · Cited by 18
“Furthermore, supplementation with vitamin C attenuates markers of oxidative stress in the plasma of exercising claudicants (Silvestro et al. 2002), and attenuates neutrophil infiltration and oedema following prolonged ischaemia–reperfusion in skeletal muscle (Kearns et al.”
BackgroundFrançois, M. E., & Little, J. P. (2017) · European Journal of Applied Physiology · doi:10.1007/s00421-017-3649-2 · Cited by 16
Ritti‐Dias, R. M., Correia, M. D. A., Andrade-Lima, A., & Cucato, G. G. (2018) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2019.1553676 · Cited by 16
Coolen, S. A. J., Daykin, C. A., van Duynhoven, J., van Dorsten, F. A., Wülfert, F., Mathot, J. N. J. J., Scheltinga, M. R., Stroosma, O. B., Vader, H. L., & Wijnen, M. H. W. A. (2008) · NMR in Biomedicine · doi:10.1002/nbm.1242 · Cited by 17
de Oliveira, G. V., Cordeiro, E. M., Volino‐Souza, M., Rezende, C., Conte‐Júnior, C. A., & Álvares, T. S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17145194 · Cited by 16
“Despite the abundance of evidence regarding the positive effects of long-term resistance training on the FMD response [11,12] studies showed increased [13–15] or reduced FMD [16,17] after a single aerobic and resistance exercise session.”
Background
Metadata
- Authors
- Silvestro, A., Scopacasa, F., Oliva, G., de Cristofaro, T., Iuliano, L., & Brevetti, G.
- Affiliations
- Federico II University Hospital (IT)
- Sapienza University of Rome (IT)
- Corresponding author
- Silvestro, Antonio
- Venue
- Atherosclerosis
- Publisher
- Elsevier BV
- Published
- 2002-12
- Volume
- 165
- Issue
- 2
- Pages
- 277-283
- ISSN
- 0021-9150 (ISSN-L)
- OpenAlex
- W2069490874
- Cited by
- 159
- References
- 43
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 1 · 2023: 1 · 2021: 7 · 2020: 4 · 2019: 3 · 2018: 8 · 2017: 9 · 2016: 9 · 2015: 10 · 2014: 14 · 2013: 11 · 2012: 17
- FWCI
- 3.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Atherosclerosis (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
- Health Sciences › Medicine › Physiology (medical) › Exercise and Physiological Responses
- Keywords
- vitamin C, intermittent claudication, endothelial dysfunction, acute exercise, oxidative stress, flow-mediated dilation, TBARS, soluble intercellular adhesion molecule-1, antioxidant therapy, peripheral arterial disease, submaximal exercise
- MeSH terms
- Antioxidants, Ascorbic Acid, Brachial Artery, Endothelium, Vascular, Exercise Test, Female, Humans, Intermittent Claudication, Male, Middle Aged, Vasodilation, Exercise, Treatment Outcome, Oxidative Stress, Intercellular Adhesion Molecule-1
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