Circulating vitamin D levels are associated with the presence and severity of coronary artery disease but not peripheral arterial disease in patients undergoing coronary angiography
Introduction
Worldwide, cardiovascular disease (CVD) is the most common cause of morbidity and remains the number one cause of death despite improved understanding of CVDs and effective therapies which have resulted in improved outcomes in these patients [1]. To further reduce CV events, novel risk factors need to be identified. Recent observational and prospective studies have shown an association between vitamin D deficiency and hypertension, diabetes mellitus, metabolic syndrome, coronary and peripheral arterial disease (PAD), and heart failure [2], [3]. Vitamin D, a secosteroid molecule, is known traditionally to play a role in calcium homeostasis and bone metabolism. Interestingly, vitamin D has been shown to exert a wider range of biological activities. These include reduction in blood pressure through down regulation of the renin–angiotensin system (RAS) [4], enhancement in insulin secretion and insulin sensitivity [5] protection against angiogenesis [6] and regulation of cellular differentiation and proliferation through locally-formed calcitriol in tissues [7].
Globally, vitamin D deficiency is a re-emerging public health problem, being found in approximately 30%–50% of the general population [8], [9]. There have been conflicting data published concerning the relationship between vitamin D and the extent of atherosclerotic disease. Some studies suggest a relationship exists while others have shown no such relationship [10], [11]. Furthermore, there is limited literature regarding what if any association exists between vitamin D status and peripheral arterial disease and arterial stiffness. In the current study, we investigated the relationship between serum 25-hydroxyvitamin D levels, extent of coronary artery disease as assessed by coronary angiography and the presence of peripheral arterial disease measured with ankle brachial index (ABI) and arterial stiffness.
Section snippets
Study population
375 patients undergoing coronary angiography at the Alfred Hospital Cardiac Catheterisation Laboratory between the period of November 2012 to September 2013 were prospectively recruited. Relevant current diagnoses, co-morbidities and current medication list were identified from inpatient and outpatient medical files.
The inclusion criteria included patients undergoing a coronary angiogram, patients who consented to additional vitamin D, calcium and phosphate blood tests within 3 months of the
Results
There were a total of 375 patients recruited mean age was 66.0 ± 11.2 (mean ± SD). Baseline characteristics and co-morbidities are shown in Table 1 and current cardiac medications in Table 2. Hypertension and hyperlipidemia were common co-morbidities amongst study patients. Diabetes was a less common co-morbidity (25.8%). 273 patients had normal renal function, 81 patients had stage 3 CKD (eGFR of 30–60 mL/min) and 6 patients had stage 4 CKD (eGFR <30 mL/min).
The majority of patients, as
Discussion
The key finding of this study was that serum 25 OHD levels were negatively associated with the presence and extent of angiographic CAD. Stepwise regression revealed that age, gender, hypertension, hyperlipidemia and 25(OH)D were appropriate models for CAD prediction, whilst DM was an appropriate predictor for PAD. However, 25(OH)D was not significantly associated with arterial stiffness or PAD. To our knowledge, this is the first study assessing the relationship of serum 25(OH)D level with
Conclusion
The current study suggests that serum 25(OH)D levels are inversely associated with coronary lesion severity established by coronary angiography, but not with arterial stiffness or PAD. While mechanistic studies have shown potential mechanisms by which vitamin D supplementation may be cardioprotective, further studies are required to determine whether vitamin D interventions prevent the development and progression of CVD and ultimately reduce clinical end points such as myocardial infarction and
Funding
This works was supported by an National Health and Medical Research (NHMRC) program grant. Grant number 1036352.
Competing interests
The authors have no conflicts of interest to disclose.
Acknowledgements
The authors would like to thank Vivian Mak, Jan Jennings and Liz Jenkins for their help with the study. Dr Dart and Shaw are supported by an National Health and Medical Research (NHMRC Australia) program grant and Dr Wark is supported by an NHMRC project grant.
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2016, European Journal of Vascular and Endovascular SurgeryCitation Excerpt :In a recent study, Liew et al. found an association between serum vitamin D levels and the presence and severity of coronary artery disease but failed to find a relationship between vitamin D deficiency and PAD.45 Nevertheless, as suggested by the authors, the relatively small number of patients with pathological ABI recruited to the study did not allow a definitive conclusion to be made.45 The 2014 report of the USA Agency for Healthcare Research and Quality did not consider PAD among potential health outcomes of hypovitaminosis D, owing to the lack of large studies in these patients.46
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Relationship between vitamin D and coronary artery disease in Egyptian patients
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