The American Journal of Clinical Nutrition, 1979 Mar; 32(3):511-2
Decline of coronary mortality in United States and vitamin C
Dear Sir:
In the May 1978 issue the editorial (1) summarized the reasons for a realistic optimism about the
possibility of coronary heart disease being influenced through changes in the diet; Over the past
12 years, a striking decline in coronary mortality rate has been noted in the United States,
particularly in the lower age groups (Fig. 1). Simultaneously, there has been a shift in American
dietary habits, involving a decreased consumption of cholesterol and saturated fats and an
increased consumption of polyunsaturated fats. Walker (2) assumes these nutritional changes,
alongside a lower consumption of tobacco products, a better control of hypertension, coronary
care units, exercise programs, and
FIG. I, Age adjusted (35 to 74 years) death rate from ischcmic heart disease per 100,000 population and production of ascorbic acid during the
past 20 years in United States. (Sources: Vital Statistics of United Stales Census of Manufacturers, United States Department of Commerce.)
ß blockers to be responsible for the impressive decline in coronary mortality. May I suggest to
add to these favorable factors also a substantial increase in vitamin C consumption in the United
States during this period.
Vitamin C status in experimental animals affects the rate of cholesterol transformation to bile
acids, for ascorbate plays a role in la-hydroxylation of cholesterol (3-5). A chronic marginal
ascorbate deficiency in guinea pigs leads to hypercholesterolemia, hypertriglyc-eridemia, a
prolongation of the half-life of plasma cholesterol, cholesterol accumulation in tissues and blood
vessels, and atheroma-tous changes hi the vascular system (6-9). An enhanced ascorbate intake
tends to improve these disorders and favorably to affect also the vascular wall metabolism (9,
10). A long-term administration of ascorbic acid to subjects with a low vitamin C intake
depresses hypercholesterolemia and hypertriglyceride-mia (9). Bates et al. (11) found a positive
correlation between ascorbate level in leukocytes and high-density cholesterol. In Great Britain,
a significantly lower coronary mortality rate has been reported from regions with a higher intake
of vitamin C (12).
I have not at my disposal any exact data on changes in vitamin C consumption in the United
States, but the production of ascorbic acid may serve as a certain indicator and this has had a
rising trend over the past 20 years, being particularly striking during the past decade (Fig. 1). It
might plausibly be assumed that the high intake of synthetic ascorbic acid has brought about a
substantial decrease in the incidence of marginal vitamin C deficiency and may have thereby
contributed to the marked decline in coronary mortality.
Emil Ginter, Ph.D.
Institute of Human Nutrition Research 880 30 Bratislava, Czechoslovakia
References
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1978.
2. walker, W. J. Changing United States life-style and declining vascular mortality: cause or coincidence? New Engl. J.
Med. 297: 163, 1977.
3. ginter, E, Ascorbic acid in cholesterol and bile acid metabolism. Ann. N. Y. Acad. Sci. 258: 410, 1975.
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acids in guinea-pigs. Exper-ientia 32: 687, 1976.
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258:317, 1975.
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10. verlanoieri, A. J., T. M. hollis and R. O. mumma. Effects of ascorbic acid and its 2-sulfate on rabbit aortic intimal
thickening. Blood Vessels 14: 157, 1977.
11. bates, C. J., A. R. mandal and T. J. cole. H.D.L.cholesterol and vitamin-C status. Lancet 2: 611, 1977.
12. k.nox, E. G. Ischaemic-heart-disease mortality and dietary intake of calcium. Lancet 1: 1465, 1973.