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J Thorac Cardiovasc Surg 2003;125:330-335
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Is vitamin C superior to diltiazem for radial artery vasodilation in patients awaiting coronary artery bypass grafting?

From the Departments of Cardiothoracic Surgery, Cardiology, Radiology and Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece^a; the Department of Cardiology, Athens Euroclinic, Athens, Greece^b; the Division of Clinical Care Research, Department of Medicine, Tufts-New England Medical Center, Boston, Mass^c; and the Division of Cardiothoracic Surgery, St Luke's/Roosevelt Hospital Center at Columbia University, New York, NY.^d

Received for publication Dec 12, 2001. Revisions requested May 16, 2002; revisions received May 28, 2002. Accepted for publication July 1, 2002. Address for reprints: Constantine E. Anagnostopoulos, MD, Department of Cardiothoracic Surgery, University of Ioannina School of Medicine, Ioannina 45110, Greece (E-mail: cea8{at}columbia.edu).

Objectives: We aimed to measure the vasodilating effects of vitamin C on the radial arteries of healthy subjects and to assess whether vitamin C is superior in this regard to diltiazem, a commonly used vasodilator in coronary artery bypass using radial conduits.
Methods: In a case-control study (study 1) oral single-dose vitamin C (2 g) was given to 15 healthy nonsmokers and 15 matched otherwise healthy smokers. In a randomized double-blind study (study 2) oral single-dose vitamin C (2 g, n = 15) and diltiazem (180 mg, n = 15) were compared in preoperative patients with coronary artery disease. We examined the dilation of the radial artery with high-resolution ultrasonography and measurement of the lumen surface and color Doppler images of the nondominant radial artery just before and 2 hours after drug administration.
Results: In study 1 both smokers and nonsmokers showed a significant increase in the lumen surface at 2 hours compared with at baseline (P < .001 and P = .013, respectively). The increase was larger in smokers (median, 37.5% vs 14.3%; P = .004). In study 2 both groups showed statistically significant increases in the lumen surface at 2 hours compared with at baseline (P < .001 and P = .008 for vitamin C and diltiazem, respectively). Vitamin C achieved a larger increase than diltiazem (median, 33.3% vs 18.2%; P = .016). In multivariate modeling the increase in lumen surface was independently predicted by use of vitamin C over diltiazem (+21.2%, P = .007), diabetes mellitus (+14.5%, P = .085), increased cholesterol (+26.2%, P = .001), and smoking history (+20.8%, P = .017).
Conclusions: Vitamin C is a potent acute vasodilator in both smokers and nonsmokers and is superior to diltiazem in preoperative coronary patients who need protection from vasospasm of the radial conduit.

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