VITAMIN-D DEFICIENCY AND RISK OF ACUTE CORONARY SYNDROME
DOI:
https://doi.org/10.22159/ijpps.2018v10i6.26469Keywords:
Vitamin D deficiency, Cardiovascular risk factors, Acute coronary syndromeAbstract
Objective: This study aimed to investigate the relation between vitamin D plasma concentrations and prevalence of prespecified coronary risk factors, and to assess the role of vitamin D deficiency as an independent risk factor for the acute coronary syndrome (ACS).
Methods: In this study, plasma 25-hydroxyvitamin D [25(OH)D] levels were measured in 60 consecutive ACS patients at hospital presentation, and patient data including socio-demographics and clinical variables were recorded at the time of admission. We used the Independent samples T-test and the chi-square test to compare differences in the continuous and categorical variables, respectively. The partial correlation coefficient was used to measure association between plasma vitamin D levels and acute coronary syndrome while controlling for traditional cardiovascular risk factors.
Results: This study found significant associations between low plasma vitamin D levels and prevalence of hypertension and smoking. Whereas, no significant association between low plasma vitamin D levels and prevalence of diabetes mellitus (DM) was found. There was a statistically significant correlation between vitamin D deficiency and acute coronary syndrome, even after controlling for traditional cardiovascular risk factors (P = 0.028).
Conclusion: Vitamin D deficiency is independently associated with acute coronary syndromes, and could be an independent risk factor for the acute coronary syndrome (ACS).
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References
Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab 2010;95:471–8.
Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81:353-73.
Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet 1998;351:805-6.
Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997;7:439-43.
Nesby-O’Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 2002;76:187-92.
Barakat K, Hitman GA. The emerging role of vitamin D and its receptor in the pathogenesis of acute coronary syndromes. Br J Cardiol 2006;13:9-12.
Li YC, Qiao G, Uskokovic M, Xiang W, Zheng W, Kong J. Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. J Steroid Biochem Mol Biol 2004;89–90:387-92.
Lee JH, O’Keefe JH, Bell D, Hensrud DD, Holick MF. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor? J Am Coll Cardiol 2008;52:1949-56.
Ohsawa M, Koyama T, Yamamoto K. 1,25 dihydroxy vitamin D3 and its synthetic analogs downregulate tissue factor and upregulate thrombomodulin expression in monocytic cells, counteracting the effects of TNF, and oxidised LDL. Circulation 2000;102:2867-72.
Muller K, Haahr PM, Diamant M, Rieneck K, Kharazmi A, Bendtzen K. 1,25-Dihydroxyvitamin D3 inhibits cytokine production by human blood monocytes at the post-transcriptional level. Cytokine 1992;4:506-12.
Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 2004;79:820–5.
Durgarao Y, Poornima AM, Prabha A, ARUN S, Chakrapani M, Rukmini MS. Predominance and influence of vitamin D deficiency on glycemic and lipid indices in type 2 diabetes patients: a case-control study. Asian J Pharm Clin Res 2017;10:177-80.
Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008;117:503–11.
Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med 2008;168:1174–80.
Hallak A, Malhis M, Abajy MY. Prevalence of vitamin-D deficiency in patients with acute coronary syndrome in syria. Int J Pharm Sci Nanotech 2016;9:3544-8.
Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266–81.
Wallis DE, Penckofer S, Sizemore GW. The sunshine deficit†and cardiovascular disease. Circulation 2008;118:1476-85.
Wolf M, Shah A, Gutierrez O, Ankers E, Monroy M, Tamez H, et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int 2007;72:1004–13.
Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008;168:1340-9.
Pittas AG, Chung M, Trikalinos T, Mitri J, Brendel M, Patel K, et al. Systematic review: vitamin D and cardiometabolic outcomes. Ann Intern Med 2010;152:307-14.
Alpert JS, Thygesen K, Antman E. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. J Am Coll Cardiol 2000;36:959–69.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003;42:1206–52.
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20: 1183-97.
Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006;84:18–28.
Zittermann A, Schleithoff SS, Koerfer R. Putting cardiovascular disease and vitamin D insufficiency into perspective. Br J Nutr 2005;94:483–92.
Harsh A, Vivek D, Nidhi S. Evaluation of knowledge, practices of vitamin D and attitude toward sunlight among Indian students. Asian J Pharm Clin Res 2016;9:308-13.
Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. IOF committee of scientific advisors (CSA) nutrition working group: global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009; 20:1807-20.
Brot C, Jorgensen NR, Sorensen OH. The influence of smoking on vitamin D status and calcium metabolism. Eur J Clin Nutr 1999;53:920–6.
Witham MD, Nadir MA, Struthers AD. Effect of vitamin D on blood pressure: a systematic review and meta-analysis. J Hypertens 2009;27:1948-54.
Forman JP, Giovannucci E, Holmes MD, Bischoff-Ferrari HA, Tworoger SS, Willett WC, et al. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension 2007;49:1063-9.
Xiang W, Kong J, Chen S, Cao LP, Qiao G, Zheng W, et al. Cardiac hypertrophy in vitamin D receptor knockout mice: role of the systemic and cardiac renin-angiotensin systems. Am J Physiol Endocrinol Metab 2005;288:125-32.
Grimnes G, Figenschau Y, Almas B, Jorde R. Vitamin D insulin secretion,sensitivity, and lipids: results from a case-control study and a randomized controlled trial using hyperglycemic clamp technique. Diabetes 2011;60:2748–57.
De las Heras J, Rajakumar K, Lee S, Bacha F, Holick MF, Arslanian SA. 25-Hydroxyvitamin D in obese youth across the spectrum of glucose tolerance from normal to prediabetes to type 2 diabetes. Diabetes Care 2013;36:2048–53.
Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol 2010:351-85. Doi:10.1155/2010/351385.
Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;72:690–3.
Kabadi SM, Lee BK, Liu L. Joint effects of obesity and vitamin D insufficiency on insulin resistance and type 2 diabetes: results from the NHANES 2001–2006. Diabetes Care 2012;35:2048–54.
Lee JH, Gadi R, Spertus JA, Tang F, O'Keefe JH. Prevalence of vitamin D deficiency in patients with acute myocardial infarction. Am J Cardiol 2011;107:1636-8.
Correia LC, Sodre F, Garcia G, Sabino M, Brito M, Kalil F, et al. Relation of severe deficiency of vitamin D to cardiovascular mortality during acute coronary syndromes. Am J Cardiol 2013;111:324-7.
Aggarwal N, Reis JP, Michos ED. Vitamin D deficiency and its implications on cardiovascular disease. Curr Cardio Risk Rep 2010;4:68-75.
Brewer LC, Michos ED, Reis JP. Vitamin D in atherosclerosis, vascular disease, and endothelial function. Curr Drug Targets 2011;12:54–60.
Kim DH, Sabour S, Sagar, Adams S, Whellan DJ. Prevalence of hypovitaminosis D in cardiovascular diseases (from the National Health and Nutrition Examination Survey 2001 to 2004). Am J Cardiol 2008;102:1540–4.
Pilz S, Tomaschitz A, Marz W, Drechsler C, Ritz E, Zittermann A, et al. Vitamin D, cardiovascular disease and mortality. Clin Endocrinol (Oxf) 2011;75:575–84.