BERKELEY, CALIFORNIA. There is now ample evidence that atherosclerosis and cardiovascular disease involve a systemic inflammatory process. The extent of the systemic inflammation can be ascertained by measuring the blood level of C-reactive protein (high-sensitivity C-reactive protein or CRP). The American Heart Association has designated a CRP concentration of less than 1.0 mg/L (< 0.1 mg/dL) as representing low risk for cardiovascular disease, a level between 1.0 and 3.0 mg/L indicates average risk, while a level above 3.0 mg/L indicates high risk.

A level above 10.0 mg/L represents acute infection or inflammation and should be disregarded when it comes to evaluating cardiovascular disease risk. There is mounting evidence that a systemic inflammation is involved not only in heart disease, but also in such varied conditions as asthma, rheumatoid arthritis, Crohn's disease, intermittent claudication, diabetes, depression, and most common cancers. There is also a clear association between elevated levels of CRP and atrial fibrillation, but at this point, it is not clear whether afib is caused by inflammation or whether sustained inflammation causes afib. In any case, a systemic inflammation is not a good thing to have and finding ways of eliminating it is clearly crucial.

A group of researchers from the University of California in Berkeley, Montefiore Medical Center in the Bronx, NY and the Children's Hospital in Oakland, CA now report that vitamin C is very effective in reducing elevated levels of CRP. Their clinical trial involved 396 healthy non-smokers who were randomized into 3 groups with group A supplementing with 1000 mg/day of vitamin C (ascorbic acid), group B supplementing with 800 IU/day of natural, mixed tocopherols (mostly alpha-tocopherol), and group C receiving a placebo. At the end of the 2-month trial, there were no statistically significant differences in CRP levels among the 3 groups. However, when a sub-group of 162 participants with an initial CRP level above 1.0 mg/L was studied separately, it became clear that vitamin C supplementation is effective in reducing CRP in people with elevated levels.

The median CRP level in the vitamin C group dropped by 0.25 mg/L or 16.7%, while the median level in the placebo group increased by 0.12 mg/L or 8.6%. The vitamin E group also experienced a slight drop in CRP, but it was not statistically significant. The researchers also observed a strong correlation between increasing BMI (body mass index) and elevated CRP with 75% of obese study participants having a CRP level above 1.0 mg/L.

The researchers point out that several studies have shown that statin drugs also reduce CRP levels. Five years of treatment with pravastatin (Pravachol) was found to reduce CRP by 17.4% in a group of heart attack patients. Lovastatin (Mevacor) was found to reduce CRP by 14.8% after treatment for one year. The more recent JUPITER trial involving rosuvastatin (Crestor) found a CRP reduction of 29% after 2 years when compared with the placebo group. This corresponds to the 25% reduction after 2 months when the vitamin C group is compared to its placebo group. The researchers conclude that the CRP-lowering effect of vitamin C is virtually identical to that of statin drugs.

Block, G, et al. Vitamin C treatment reduces elevated C-reactive protein. Free Radical Biology & Medicine, Vol. 46, 2009, pp. 70-77

Editor's comment: The finding of the JUPITER trial that reducing CRP also reduces the risk of cardiovascular disease is clearly of huge importance. However, of equal importance is the finding that this CRP reduction can be achieved by simply supplementing with vitamin C rather than by taking expensive and dangerous statin drugs.