Co-Administration of Vitamin C and Thiamine (Vitamin B1) Improves Inflammatory Outcomes Post Cardiac Surgery

by | Apr 16, 2025 | 2025, Cardiovascular Health, Recent Articles, Vitamin B - General, Vitamin C

Written by Chrystal Moulton, Science Writer. Patients in the vitamin C and B1 group had significantly lower levels of LDH, Troponin-I, and CK-MB immediately after surgery and 24h post-op (P<0.05).

cardiovascular healthCardiopulmonary bypass is a procedure that sends the blood through a machine which oxygenates the blood and sends it back into the body allowing surgeons to perform heart surgeries. This procedure, however, is associated with a systemic inflammatory response in the body1,2. Reducing the effect of the inflammatory response is essential to patient prognosis3. Vitamin C and thiamine (vitamin B1) are antioxidants essential to overall health. Previous studies have shown the beneficial effects of vitamin C and thiamine individually in reducing oxidative stress in patients undergoing heart surgery4-7. However, very few studies have investigated the administration of both antioxidants during cardiac surgeries. In the current study, researchers investigated the effect of vitamins C and B1 versus vitamin C alone on the postoperative effects of cardiac surgery8.

The study was conducted in a hospital within the operating room and the ICU. It was designed as a randomized, prospective, double-blind, controlled trial. Patients who were 18 years or older, scheduled for elective open-heart surgery with no known coagulopathy were eligible for this trial. Patients also had to have a left ventricular ejection fraction (LVEF) >35%. Patients were excluded if they have any allergies to vitamin C or thiamine, was administered vitamin C or thiamine 7 days before the surgery, was already participating in another trial, or had a history of autoimmune disease or atrial fibrillation. Several other disqualifying factors included pregnancy, immunosuppression therapy, malignancy or infection, bleeding disorders, and mechanical ventilation or vasopressor on the day of surgery. Eligible participants were randomly assigned to receive 1000mg vitamin C and 100mg vitamin B1 or 1000mg vitamin C only in normal saline administered intravenously over 30min. The assigned intervention was given after anesthesia induction, after separation from the cardiopulmonary bypass machine, 12h post-operation, and 24h post-operation. The same anesthesia and medicines were provided to each participant according to standard protocol during and post operation. Left ventricular ejection fraction (LVEF) was evaluated before, during, and 24hrs after the operation was completed. The primary outcome was changes in inflammatory biomarkers including IL-6, white blood cells, troponin-I, lactate dehydrogenase (LDH), creatine kinase – MB (CK-MB), and C-reactive protein (CRP). Secondary outcomes include changes in blood pressure, mean arterial pressure (MAP), and percent change in left ventricular ejection fraction (LVEF).

Sixty-four eligible participants were randomly assigned to receive vitamin C and B1 or vitamin C alone. The use of diuretics (P=0.04), ACE-inhibitors (P=0.032), and statins (P=0.046) were significantly different between both groups. Use of these medications were significantly higher in those assigned to vitamin C only. Left ventricular hypertrophy was also significantly higher in the vitamin C only group (P=0.022).  However, the prevalence of comorbidities and demographic data was similar [non-significant] between both groups. Regarding inflammatory biomarkers, researchers observed that IL-6 was significantly lower immediately after surgery in the vitamin C and B1 group (P=0.003). However, no significant difference was observed 24h post-op. No significant difference was observed for white blood cell count or CRP levels at all time points between the groups. Patients in the vitamin C and B1 group had significantly lower levels of LDH, Troponin-I, and CK-MB immediately after surgery and 24h post-op (P<0.05) compared to the vitamin C only group. No significant differences were observed in lactate levels, hemodynamic changes (i.e. blood pressure and MAP), nor LVEF between groups. Researchers also noted that individuals in the vitamin C and B1 group had a lower incidence of arrythmias (0 vs. 16.1%, P=0.022) and shorter average cardiopulmonary bypass duration (107.8 v. 128.6 min, P=0.009) and dobutamine use (7.7 ±8.8h vs. 14.8 ±8.5h, P=0.049) compared to the vitamin C only group, respectively.

Overall, results from this trial indicate that coadministration of vitamin C and B1 (thiamine) versus vitamin C alone significantly lowers biomarkers of myocardial injury (CK-MB, Troponin-I, IL-6, and LDH) while reducing the incidence of heart arrythmias and dobutamine use 24h post operation. Additional studies will be needed to verify these findings.

Source: Saetang, Mantana, Wirat Wasinwong, Maliwan Oofuvong, Jutarat Tanasansutthiporn, Laortip Rattanapittayaporn, Sutthasinee Petsakul, Pongsanae Duangpakdee et al. “Effect of Combined Vitamin C and Thiamine Therapy on Myocardial and Inflammatory Markers in Cardiac Surgery: A Randomized Controlled Clinical Trial.” Nutrients 17, no. 6 (2025): 1006.

© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/
licenses/by/4.0/).

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Posted April 16, 2025.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

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