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First published online on November 16, 2006.
Copyright © 2006 by The Physiological Society
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Received October 3, 2006
Revised October 24, 2006
Accepted after revision October 26, 2006

The effects of acute oral antioxidants on diving-induced alterations in cardiovascular function

Ante Obad1, Ivan Palada1, Zoran Valic1, Vladimir Ivancev1, Darija Bakovic1, Ulrik Wisloff2, Alf O Brubakk2, and Zeljko Dujic3*

1 University of Split School of Medicine, Split, Croatia
2 Norwegian University of Science and Technology, Trondheim, Norway
3 University of Split School of Medicine

* To whom correspondence should be addressed. E-mail: zdujic{at}bsb.mefst.hr.

Diving-induced acute alterations in cardiovascular function such as arterial endothelial dysfunction, increased pulmonary artery pressure (PAP) and reduced heart function have been recently reported. We tested the effects of acute antioxidants on arterial endothelial function, PAP and heart function before and after field dive. Vitamin C (2 grams) and E (400 IU) were given to subjects 2 hours before second dive (protocol 1) and in placebo-controlled crossover study design (protocol 2). Seven experienced divers performed open sea dives to 30 msw with standard decompression in non randomized protocol, and six of them participated in randomized trial. Before and after the dives ventricular volumes and function and pulmonary and brachial artery function were assessed by ultrasound. The control dive resulted in a significant reduction in flow mediated dilation (FMD) and heart function with increased mean PAP. 24 hours (h) after the control dive FMD was still reduced 37% (8.1 vs. 5.1%, p=0.005 below baseline, while right ventricle ejection fraction (RV-EF), left ventricle EF and endocardial fractional shortening were reduced much less (~2-3%). At the same time RV end-systolic volume was increased by 9% and mean PAP by 5%. Acute antioxidants significantly attenuated only the reduction in FMD postdive (p<0.001), while changes in pulmonary artery and heart function were unaffected by antioxidant ingestion. These findings were confirmed by repeating the experiments in a randomized study design. FMD returned to baseline values 72h after the dive with pre-dive placebo, whereas for most cardiovascular parameters this occurred earlier (24-48h). Right ventricular dysfunction and increased PAP lasted longer. Acute antioxidants attenuated arterial endothelial dysfunction after diving, while reduction in heart and pulmonary artery function were unchanged. Cardiovascular changes after diving are not fully reversed up to 3 days after a dive, suggesting longer lasting negative effects.


Key words: Antioxidant system • Diving • Endothelium




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