Vitamin C for preventing atrial fibrillation in high risk patients: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Atrial fibrillation (AF), a common arrhythmia contributing substantially to cardiac morbidity, is associated with oxidative stress and, being an antioxidant, vitamin C might influence it. METHODS: We searched the Cochrane CENTRAL Register, MEDLINE, and Scopus databases for randomised trials on vitamin C that measured AF as an outcome in high risk patients. The two authors independently assessed the trials for inclusion, assessed the risk of bias, and extracted data. We pooled selected trials using the Mantel-Haenszel method for the risk ratio (RR) and the inverse variance weighting for the effects on continuous outcomes. RESULTS: We identified 15 trials about preventing AF in high-risk patients, with 2050 subjects. Fourteen trials examined post-operative AF (POAF) in cardiac surgery patients and one examined the recurrence of AF in cardioversion patients. Five trials were carried out in the USA, five in Iran, three in Greece, one in Slovenia and one in Russia. There was significant heterogeneity in the effect of vitamin C in preventing AF. In 5 trials carried out in the USA, vitamin C did not prevent POAF with RR = 1.04 (95% CI: 0.86-1.27). In nine POAF trials conducted outside of the USA, vitamin C decreased its incidence with RR = 0.56 (95% CI: 0.47-0.67). In the single cardioversion trial carried out in Greece, vitamin C decreased the risk of AF recurrence by RR = 0.13 (95% CI: 0.02-0.92). In the non-US cardiac surgery trials, vitamin C decreased the length of hospital stay by 12.6% (95% CI 8.4-16.8%) and intensive care unit (ICU) stay by 8.0% (95% CI 3.0-13.0%). The US trials found no effect on hospital stay and ICU stay. No adverse effects from vitamin C were reported in the 15 trials. CONCLUSIONS: Our meta-analysis indicates that vitamin C may prevent post-operative atrial fibrillation in some countries outside of the USA, and it may also shorten the duration of hospital stay and ICU stay of cardiac surgery patients. Vitamin C is an essential nutrient that is safe and inexpensive. Further research is needed to determine the optimal dosage protocol and to identify the patient groups that benefit the most.
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The data on the effect of vitamin C on clinical outcomes in patients undergoing cardiac surgery is still insufficient to draw firm conclusions.
“The data on the effect of vitamin C on clinical outcomes in patients undergoing cardiac surgery is still insufficient to draw firm conclusions [191,192,193,194].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [193]
The Conclusions say that findings differ by country and that further trials should identify which patients benefit, supporting uncertainty about general conclusions. But the paper does draw conclusions for the outcomes it examines—atrial fibrillation and length of stay—including no benefit in the US cardiac-surgery trials. It does not assess clinical outcomes broadly. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSome recent systematic reviews and meta-analyses suggested that vitamin C significantly decreased the incidence of atrial fibrillation, ventilation time, length-of-stay in the intensive care unit, and hospital length-of-stay, but it had no significant effect on in-hospital mortality or incidence of stroke, acute kidney injury, or ventricular arrhythmia in cardiac surgery patients.
“Some recent systematic reviews and meta-analyses suggested that vitamin C significantly decreased the incidence of atrial fibrillation, ventilation time, length-of-stay in the intensive care unit, and hospital length-of-stay, but it had no significant effect on in-hospital mortality or incidence of stroke, acute kidney injury, or ventricular arrhythmia in cardiac surgery patients.”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [193]
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References 36 · Cited by 94
Research works printed but not linked: 1
- [33]Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2014. http://community.cochrane.org/tools/review-production-tools/revman-5. Accessed 4 Dec 2016.
- Authors
- Hemilä, H., & Suonsyrjä, T.
- Affiliations
- University of Helsinki (FI)
- Helsinki University Hospital (FI)
- Corresponding author
- Hemilä, Harri
- ORCID
- Hemilä, Harri
- Venue
- BMC Cardiovascular Disorders
- Published
- 2017-02-01
- Volume
- 17
- Issue
- 1
- Pages
- 49-49
- ISSN
- 1471-2261 (ISSN-L)
- PMC
- PMC5286679
- OpenAlex
- W2584760661
- Cited by
- 94
- References
- 36
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 8 · 2023: 13 · 2022: 15 · 2021: 12 · 2020: 10 · 2019: 16 · 2018: 12 · 2017: 2
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Cardiovascular Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- Funders
- Tehran University of Medical Sciences and Health Services
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Nursing › Nutrition and Dietetics › Vitamin C and Antioxidants Research
- Keywords
- vitamin C, atrial fibrillation, postoperative atrial fibrillation, cardiac surgery, atrial fibrillation recurrence, cardioversion, oxidative stress, antioxidants, length of hospital stay, ICU length of stay, high-risk patients
- MeSH terms
- Aged, Antioxidants, Ascorbic Acid, Atrial Fibrillation, Female, Humans, Length of Stay, Male, Middle Aged, Postoperative Complications, Recurrence, Risk Factors, Time Factors, Incidence, Chi-Square Distribution, Odds Ratio, Randomized Controlled Trials as Topic, Treatment Outcome, Oxidative Stress
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