Associations between vitamin D and cardiovascular outcomes; Tehran Lipid and Glucose Study (original) (raw)
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Atherosclerosis, 2009
Objective: Serum 25-hydroxyvitamin D [25(OH)D] levels are inversely associated with important cardiovascular disease (CVD) risk factors. However, the association between 25(OH)D levels and prevalent CVD has not been extensively examined in the general population. Methods: We performed a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey (1988-1994) and examined the association between serum 25(OH)D levels and prevalence of CVD in a representative population-based sample of 16,603 men and women aged 18 years or older. Prevalence of CVD was defined as a composite measure inclusive of self-reported angina, myocardial infarction or stroke. Results: In the whole population, there were 1308 (8%) subjects with self-reported CVD. Participants with CVD had a greater frequency of 25(OH)D deficiency [defined as serum 25(OH)D levels <20 ng/mL] than those without (29.3% vs. 21.4%; p < 0.0001). After adjustment for age, gender, race/ethnicity, season of measurement, physical activity, body mass index, smoking status, hypertension, diabetes, elevated lowdensity lipoprotein cholesterol, hypertriglyceridemia, low high-density lipoprotein cholesterol, chronic kidney disease and vitamin D use, participants with 25(OH)D deficiency had an increased risk of prevalent CVD (odds ratio 1.20 [95% confidence interval (CI) 1.01-1.36; p = 0.03]). Conclusions: These results indicate a strong and independent relationship of 25(OH)D deficiency with prevalent CVD in a large sample representative of the US adult population.
Archives of Medical Science, 2016
Introduction: A deficiency of 25-hydroxyvitamin D (25(OH)D) (the standard biomarker for vitamin D status) can have multiple impacts on the cardiovascular system. The aim of the study was to assess of the influence of 25(OH)D on severity of coronary atherosclerosis and lipid profile. Material and methods: The study involved prospectively 637 patients subject to coronary catheterization. The stage of coronary atherosclerosis was assessed using the Coronary Artery Surgery Study score (CASSS). Plasma concentration of 25(OH)D was measured using an electrochemiluminescent immunoassay. The levels of total cholesterol (TC), high-density cholesterol (HDL-C) and triglycerides (TG) were measured using the enzymatic method, and the concentration of low-density cholesterol (LDL-C) was calculated with the Friedewald equation. Results: The average level of 25(OH)D was 15.85 ng/ml. A higher level of 25(OH)D was observed in men (16.28 ng/ml vs. 15.1 ng/ml; p = 0.027). The study did not reveal any significant correlation between the level of 25(OH)D and severity of coronary atherosclerosis. It was observed however that the increase of 25(OH)D level results in an increased number of patients without significant lesions in the coronary arteries. In the whole group of women and men in the age group of 70-80 years an inverse relationship was observed between the level of 25(OH) and the severity of coronary atherosclerosis. The whole study group showed a statistically significant inverse correlation of the 25(OH)D level with TC (p = 0.0057), LDL-C (p = 0.00037) and TG (p = 0.00017). Conclusions: Women and men over 70 years showed an inverse correlation of the 25(OH)D level and the stage of coronary atherosclerosis. Deficiency of 25(OH)D affects the levels of TC, LDL-C and TG.
The American Journal of Cardiology, 2012
We aimed to examine associations between serum 25-hydroxyvitamin D (25[OH]D) concentration and mortality from heart failure (HF) and cardiovascular disease (CVD) and premature death from all causes using data from the Third National Health and Nutrition Examination Survey, which included 13,131 participants (6,130 men, 7,001 women) >35 years old at baseline (1988 to 1994) and followed through December 2000. Premature death was defined all-cause death at <75 years of age. Results indicated that during an average 8-year follow-up, there were 3,266 deaths (24.9%) including 101 deaths from HF, 1,451 from CVD, and 1,066 premature all-cause deaths. Among HF deaths, 37% of decedents had serum 25(OH)D levels <20 ng/ml, whereas only 26% of those with non-HF deaths had such levels (p <0.001). Multivariate-adjusted Cox model indicated that subjects with serum 25(OH)D levels <20 ng/ml had 2.06 times higher risk (95% confidence interval 1.01 to 4.25) of HF death than those with serum 25(OH)D levels >30 ng/ml (p <0.001). In addition, hazard ratios (95% confidence intervals) for premature death from all causes were 1.40 (1.17 to 1.68) in subjects with serum 25(OH)D levels <20 ng/ml and 1.11 (0.93 to 1.33) in those with serum 25(OH)D levels of 20 to 29 ng/ml compared to those with serum 25(OH)D levels >30 ng/ml (p <0.001, test for trend). In conclusion, adults with inadequate serum 25(OH)D levels have significantly higher risk of death from HF and all CVDs and all-cause premature death.
Archives of Medical Science
Introduction: Ischaemic heart disease is the main cause of death in developed countries. There are many modifiable risk factors associated with coronary heart disease (CAD). A growing number of studies point to vitamin D deficiency as a risk factor for heart attacks and the conditions associated with cardiovascular disease. This study aimed to analyse the relationship between the level of 25-hydroxyvitamin D (25(OH)D) and the severity of coronary artery atherosclerosis and to study 25(OH)D levels in non-diabetic patients hospitalised due to acute coronary syndrome and those diagnosed with stable CAD. Material and methods: Coronary angiography was performed prospectively in 410 successive cardiac patients. The severity of coronary artery atherosclerosis was assessed according to the Coronary Artery Surgery Study Score (CASSS). The plasma 25(OH)D level was assessed with the electrochemiluminescence method. Results: The 25(OH)D level proved to be one of the significant determinants of the CASSS (p < 0.05). In subjects without significant lesions in the coronary arteries the 25(OH)D level was significantly higher compared to patients with one-to three-vessel coronary atherosclerosis (p < 0.05). A significantly higher 25(OH)D level was noted in patients diagnosed with stable CAD compared to patients hospitalised due to acute coronary syndrome (p < 0.01). Conclusions: Patients with one-to three-vessel atherosclerosis have a significantly lower 25(OH)D level compared to patients without significant lesions in the coronary arteries. A lower 25(OH)D level was observed in patients hospitalised due to acute coronary syndrome compared to patients diagnosed with stable CAD.
Atherosclerosis, 2012
Objective: We examined the relationships of serum 25-hydroxyvitamin D (25(OH)D) concentration to established and emerging cardiovascular risk factors and risk of myocardial infarction (MI) in a population-based caseecontrol study of MI before the age of 60 years. Methods: A total of 387 survivors of a first MI and 387 sex-and age-matched controls were included. Fasting blood samples drawn three months after the MI in cases and at the same time in the matched controls were used for biochemical analyses. Results: Serum concentrations of 25(OH)D, adjusted for seasonal variation, were lower in cases than controls (55.0 (40.0e71.0) nmol/L vs 60.5 (47.0e75.0) nmol/L; median (interquartile range); standardized odds ratio (OR) for MI with 95% confidence interval in univariable analysis: 0.80 (0.69e0.93); p ¼ 0.003). The 25(OH)D association with MI disappeared after adjustment for established and emerging risk factors (OR: 1.01 (0.82e1.25)). Current smoking and plasma levels of proinsulin and PAI-1 activity were independently associated with 25(OH)D in controls, whereas waist circumference, plasma triglycerides, proinsulin, PAI-1 activity and cystatin C, and non-Nordic ethnicity were independently associated with 25(OH)D in patients. Serial measurements of 25(OH)D (samples drawn <4 h and 3 months after the onset of MI) in 57 patients showed no systematic differences between sampling times. Conclusion: Vitamin D insufficiency, which is associated with a multitude of metabolic, procoagulant and inflammatory perturbations, is not independently related to premature MI. This suggests that vitamin D insufficiency either constitutes an epiphenomenon or increases the risk of MI by promoting established risk factor mechanisms that predispose to atherothrombosis.
The Risk of All-Cause Mortality Is Inversely Related to Serum 25(OH)D Levels
Context and Objectives: Vitamin D plays a key role in maintaining bone health, but evidence for its nonskeletal effects is inconsistent. This study aims to examine the association between serum 25-hydroxyvitamin D [25(OH)D] levels and all-cause mortality in a large general population cohort. Design, Participants, and Setting: Using the computerized database of the largest health care provider in Israel, we identified a cohort of subjects 20 years old or older with serum 25(OH)D levels measured between January 2008 and December 2009. Vital status was ascertained through August 2011. Results: Median follow-up was 28.5 months (interquartile range 23.8 –33.5 months); 7,247 of 182,152 participants (4.0%) died. Subjects who died had significantly lower serum 25(OH)D levels (mean 44.8 24.2 nmol/liter) than those alive at the end of follow-up (51.0 23.2 nmol/liter), P 0.001. After adjustment for age, gender, ethnicity, and seasonality, the hazard ratio (HR) for all-cause mortality was 2.02 [95% confidence interval (CI) 1.89 –2.15] for the lowest serum 25(OH)D quartile (33.8 nmol/liter) compared with the highest. After further adjustment for comorbidity, use of vitamin D supplements and statins, smoking, socioeconomic status, and body mass index, the HR was 1.81 (95% CI 1.69 –1.95). This remained, even after adjustment for serum low-density lipoprotein, high-density lipoprotein, calcium level (corrected for serum albumin levels), and glo-merular filtration rate, 1.85 (95% CI 1.70 –2.01). The fully adjusted HR associated with being in the second 25(OH)D quartile (33.8 – 49.4 nmol/liter) was 1.25 (95% CI 1.16 –1.34). Conclusions: All-cause mortality is independently and inversely associated with serum 25(OH)D levels at levels less than 50 nmol/liter. (J Clin Endocrinol Metab 97: 2792–2798, 2012)
Recent evidence has pointed out an association between vitamin D deficiency and coronary heart disease (CHD). Due to the growing epidemic of CHD and vitamin D deficiency in Saudi Arabia, exploring the role of vitamin D in the prevention of CHD is crucial. The aim of this study was to examine the association between vitamin D status and CHD in Saudi Arabian adults. This case-control study included 130 CHD cases and 195 age-sex matched controls. Study subjects were recruited from three hospitals in the western region of Saudi Arabia. Study participants were interviewed face-to-face to collect data on their socio-demographic characteristics and family history of CHD. Fasting blood samples were collected, and serum levels of vitamin D, glucose, and total cholesterol were measured. Body weight, height, and blood pressure measurements were also recorded. Severe vitamin D deficiency (25(OH)D < 10 ng/mL) was much more prevalent in CHD cases than in controls (46% and 3%, respectively). The results of multivariate logistic regression showed that vitamin D deficiency (25(OH)D < 20 ng/mL) was associated with CHD, with an odds ratio of 6.5 (95% CI: 2.7–15, p < 0.001). The current study revealed that vitamin D deficiency is independently associated with CHD, suggesting an important predictor of CHD among Saudi adults.
Objective: Recent literature has suggested an association between low serum vitamin D levels and the burden of cardio-metabolic risk factors (obesity, diabetes, hypertension, and hypercholesterolemia). In the context of the high prevalence of vitamin D deficiency and cardio-metabolic risk factors in Saudi Arabia, this study was designed to examine the association between vitamin D deficiency and cardio-metabolic risk factors among adults with coronary heart disease (CHD) and without CHD in Saudi Arabia. Methods: A total of 130 CHD subjects and 195 subjects without CHD were recruited from three hospitals in the western region of the Kingdom. Fasting blood samples were collected from each subject to measure serum levels of vitamin D, glucose, and total cholesterol. Anthropometric and blood pressure were also measured. Results: Subjects with CHD had a higher prevalence of diabetes (35.4% and 14%, respectively) and obesity (44% and 22%, respectively) compared with subjects without CHD. However, subjects without CHD had a higher prevalence of cholesterol (13.3% and 5.4%, respectively) and overweight (45% and 24.4%, respectively) than subjects with CHD. The results indicated that vitamin D deficiency [serum 25(OH)D<20 ng/mL] was associated with increased risk of diabetes in CHD subjects (OR: 2.9, 95% CI: 1.02-8.5, p=0.04), while there was no association observed in subjects without CHD (OR:1.4, 95% CI: 0.5-3.8, p=0.616). No significant associations were found between vitamin D deficiency and other cardio-metabolic risk factors including obesity, hypertension, and hypercholesterolemia, in either group. Conclusion: The present study reveals that vitamin D deficiency was associated with a higher risk of diabetes only in subjects with CHD, but not in subjects without CHD. However, this differential association between vitamin D deficiency and other cardio-metabolic risk factors was not observed. Further studies are needed to confirm these findings.
Serum 25-hydroxyvitamin D concentration, established and emerging risk factors
2012
Objective: We examined the relationships of serum 25-hydroxyvitamin D (25(OH)D) concentration to established and emerging cardiovascular risk factors and risk of myocardial infarction (MI) in a population-based caseecontrol study of MI before the age of 60 years. Methods: A total of 387 survivors of a first MI and 387 sex-and age-matched controls were included. Fasting blood samples drawn three months after the MI in cases and at the same time in the matched controls were used for biochemical analyses. Results: Serum concentrations of 25(OH)D, adjusted for seasonal variation, were lower in cases than controls (55.0 (40.0e71.0) nmol/L vs 60.5 (47.0e75.0) nmol/L; median (interquartile range); standardized odds ratio (OR) for MI with 95% confidence interval in univariable analysis: 0.80 (0.69e0.93); p ¼ 0.003). The 25(OH)D association with MI disappeared after adjustment for established and emerging risk factors (OR: 1.01 (0.82e1.25)). Current smoking and plasma levels of proinsulin and PAI-1 activity were independently associated with 25(OH)D in controls, whereas waist circumference, plasma triglycerides, proinsulin, PAI-1 activity and cystatin C, and non-Nordic ethnicity were independently associated with 25(OH)D in patients. Serial measurements of 25(OH)D (samples drawn <4 h and 3 months after the onset of MI) in 57 patients showed no systematic differences between sampling times. Conclusion: Vitamin D insufficiency, which is associated with a multitude of metabolic, procoagulant and inflammatory perturbations, is not independently related to premature MI. This suggests that vitamin D insufficiency either constitutes an epiphenomenon or increases the risk of MI by promoting established risk factor mechanisms that predispose to atherothrombosis.