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Algowhary M, Farouk A, El-Deek HEM, Hosny G, Ahmed A, Abdelzaher LA, Saleem TH. Relationship between vitamin D and coronary artery disease in Egyptian patients. Egypt Heart J 2023; 75:92. [PMID: 37943388 PMCID: PMC10635996 DOI: 10.1186/s43044-023-00419-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Previous studies have reported conflicting results about the association of vitamin D (VD) level with coronary artery disease (CAD). We aimed to study the association of VD with atherosclerotic CAD in Egyptian individuals. RESULTS We prospectively enrolled 188 consecutive CAD patients with a median age of 55(50-62) years; 151(80.3%) were male. All patients were diagnosed by cardiac catheterization and were compared with 131 healthy controls. VD levels were measured in serum samples of all participants. Compared to controls, CAD patients had a significantly lower median VD level, 14.65 (9.25-21.45) versus 42.0 (32.0-53.0) ng/mL, p < 0.001. VD was correlated with the number of diseased coronary arteries and lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides, p < 0.001 for each). By multivariate analyses, VD was an independent predictor of CAD [OR 1.22 (95% CI 1.07-1.4), p = 0.003, optimal cut-off value 30 ng/mL (AUC 0.92, sensitivity 81% and specificity 81.4%), p < 0.001], and the number of diseased coronary arteries, p < 0.001, especially three-vessel disease [OR 0.83 (95% CI 0.72-0.95), p = 0.008]. CONCLUSIONS We have shown that low VD should be considered a non-traditional risk factor for CAD in Egyptian individuals. Low VD was correlated with coronary atherosclerosis, especially in patients with multivessel effects.
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Affiliation(s)
- Magdy Algowhary
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Asyut, 71516, Egypt.
| | - Ahmed Farouk
- Department of Cardiothoracic Surgery, Assiut University Heart Hospital, Assiut University, Asyut, 71516, Egypt
| | - Heba E M El-Deek
- Department of Pathology, Faculty of Medicine, Assiut University, Asyut, 71516, Egypt
| | - Ghada Hosny
- Department of Pathology, Faculty of Medicine, Assiut University, Asyut, 71516, Egypt
| | - Ahmed Ahmed
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Asyut, 71516, Egypt
| | - Lobna A Abdelzaher
- Department of Pharmacology, Faculty of Medicine, Assiut University, Asyut, 71516, Egypt
| | - Tahia H Saleem
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Asyut, 71516, Egypt
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Mehta A, Chokka D, N. S, Seshu A, R. P, M. MP. Correlation of vitamin D level and severity of coronary artery disease. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i5.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction and Aim: Cardiovascular diseases are the leading cause of death worldwide. The prevalence of cardiovascular disease in India is continuously on the rise owing to the socioeconomic changes the country is undergoing. In order to minimise the mortality due to cardiovascular disease, early detection and control of modifiable risk factors is of utmost importance. We evaluated the correlation of vitamin D deficiency, one such possible modifiable risk factor, and the severity of CAD in patients at a hospital in Southern Karnataka. Unfortunately, relevant data regarding vitamin D deficiency in coronary artery disease pertaining to the Indian subcontinent is scarce. Thus, the results of our study can provide further evidence for the potential therapeutic benefit of Vitamin D in patients with cardiovascular risk factors, which in the long run can significantly reduce the morbidity and mortality of CAD.
Materials and Methods: A case-control study with 142 subjects was conducted in Kasturba Hospital. Based on coronary angiogram findings, cases were categorised as having single, double, triple or multi vessel disease. Vitamin D level was quantified into 3 categories: normal (>30ng/ml), insufficient (20-30ng/ml) and deficient (<20ng/ml).
Results: Vitamin D deficiency was statistically significantly and inversely related to the number of vessels involved (multi vessel disease-83.3%, triple vessel disease-80%, double vessel disease-28.6% and single vessel disease-21.7%). The relationship between vitamin D levels and syntax scoring showed a negative correlation (-0.339). Multiple linear regression analysis showed that the severity of CAD was correlated to diabetes and vitamin D deficiency with p-value of 0.014.
Conclusion: Both our results and those of previous studies suggest that vitamin D could have a potential therapeutic effect in CAD.
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Izzo M, Carrizzo A, Izzo C, Cappello E, Cecere D, Ciccarelli M, Iannece P, Damato A, Vecchione C, Pompeo F. Vitamin D: Not Just Bone Metabolism but a Key Player in Cardiovascular Diseases. Life (Basel) 2021; 11:life11050452. [PMID: 34070202 PMCID: PMC8158519 DOI: 10.3390/life11050452] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022] Open
Abstract
Vitamin D is the first item of drug expenditure for the treatment of osteoporosis. Its deficiency is a condition that affects not only older individuals but also young people. Recently, the scientific community has focused its attention on the possible role of vitamin D in the development of several chronic diseases such as cardiovascular and metabolic diseases. This review aims to highlight the possible role of vitamin D in cardiovascular and metabolic diseases. In particular, here we examine (1) the role of vitamin D in diabetes mellitus, metabolic syndrome, and obesity, and its influence on insulin secretion; (2) its role in atherosclerosis, in which chronic vitamin D deficiency, lower than 20 ng/mL (50 nmol/L), has emerged among the new risk factors; (3) the role of vitamin D in essential hypertension, in which low plasma levels of vitamin D have been associated with both an increase in the prevalence of hypertension and diastolic hypertension; (4) the role of vitamin D in peripheral arteriopathies and aneurysmal pathology, reporting that patients with peripheral artery diseases had lower vitamin D values than non-suffering PAD controls; (5) the genetic and epigenetic role of vitamin D, highlighting its transcriptional regulation capacity; and (6) the role of vitamin D in cardiac remodeling and disease. Despite the many observational studies and meta-analyses supporting the critical role of vitamin D in cardiovascular physiopathology, clinical trials designed to evaluate the specific role of vitamin D in cardiovascular disease are scarce. The characterization of the importance of vitamin D as a marker of pathology should represent a future research challenge.
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Affiliation(s)
- Marcello Izzo
- Department of Mathematics for Technology, Medicine and Biosciences Research Center, University of Ferrara, 44121 Ferrara, Italy
- Specialist Medical Center-Via Cimitile, 80035 Nola, Italy
- Correspondence:
| | - Albino Carrizzo
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Enrico Cappello
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Domenico Cecere
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Patrizia Iannece
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Antonio Damato
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Carmine Vecchione
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Francesco Pompeo
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
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Vitamin D Deficiency May Not Be an Independent Risk Factor for Peripheral Arterial Disease in Middle-Aged and Elderly Patients with Type 2 Diabetes in China. DISEASE MARKERS 2020; 2020:8854717. [PMID: 33299499 PMCID: PMC7710426 DOI: 10.1155/2020/8854717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022]
Abstract
Background Vitamin D deficiency can lead to the increased severity and prevalence of metabolic disorders. However, the relationship between levels of 25-hydroxyvitamin D (25(OH)D) and peripheral arterial disease (PAD) is controversial. Therefore, the purpose of our study was to explore the relationship between 25(OH)D levels and PAD in middle-aged and elderly type 2 diabetes mellitus (T2DM) patients in China. Methods In this study, a total of 183 patients with T2DM were enrolled and categorized into groups with or without PAD. Clinical and biochemical parameters were assessed, and a Pearson analysis was used to identify a possible association between levels of 25(OH)D and glycated hemoglobin (HbA1c). Some biochemical parameters were also assessed in the T2DM patients with PAD according to vitamin D status. Interactions were also explored among HbA1c control, 25(OH)D levels, and PAD. The possible risk factors for PAD were measured by multivariable logistic regression analyses. Results Firstly, the parameters including age, HbA1c, and disease duration between T2DM and T2DM+PAD groups showed significantly different. In addition, the frequency of smoking in the group of T2DM patients was significantly less than that in the T2DM patients with the PAD group, while the frequency of well-controlled HbA1c in the patients with T2DM was significantly higher. There is a trend that the levels of 25(OH)D and HbA1c are correlated, but no interactions among vitamin D deficiency, HbA1c control, and PAD were found. However, HbA1c significantly differed between groups with vitamin D deficiency and insufficiency in the T2DM patients with PAD. According to the multivariate logistic regression analyses, the PAD risk factors of T2DM patients were family history of diabetes, smoking, age, disease duration, HbA1c, and LDL. Conclusions The findings demonstrate that the deficiency of vitamin D level is not related to PAD, but HbA1c may be linked to the presence of PAD in middle-aged and elderly patients with T2DM in China.
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Birgani FK, Shahi MM, Cheraghian B, Haybar H. Investigating the Relationship the Severity of Coronary Artery Disease with Serum Levels of Vitamin D in Men after Eliminating the Effect of Diet. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401314666181105143051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Coronary artery disease (CAD) is one of the most common cardiovascular diseases that can lead to mortality, inability, and lower productivity levels.Objective:The aim of this study was to determine the relationship between serum vitamin D level and cardiovascular risk factors and the severity of CAD after determining and eliminating the confounding effects of dietary patterns in male patients undergoing angiography.Methods:This descriptive-analytic study was carried out on 132 men undergoing angiography during 2017 and 2018. To this end, food frequency questionnaire (FFQ) and physical activity questionnaire (PAQ) were completed for the patients. Fasting blood sugar (FBS), triglyceride, total cholesterol, HDL-C, LDL-C and vitamin D levels were also investigated.Results:Serum vitamin D levels significantly decreased with an increase in CAD severity (p=0.001). Also, low serum levels led to the highest severity of CAD (p=0.005). However, there was no significant difference between patients with vitamin D deficiency with different degrees of CAD (p=0.084). Also, the highest percentage of individuals with normal serum levels of vitamin D was observed in the group without any blocked blood arteries (normal) (p=0.023).Conclusion:This study shows an inverse relationship between serum 25(OH) D level and the severity of CAD. Our data show that vitamin D plays an important role in preventing CAD. These findings could help design prospective studies and clinical trials on a wider scale to investigate the effects of vitamin D interventions in preventing the development of CAD.
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Affiliation(s)
- Farshad K. Birgani
- Department of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid M. Shahi
- Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Epidemiology, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Habib Haybar
- Cardiovascular Research Center and Department of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Bonatto S, Paniz VMV, Dutra CDF, Henn RL. Vitamin D serum levels and peripheral arterial disease among southern Brazilian adults. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2020; 66:268-274. [PMID: 32520144 DOI: 10.1590/1806-9282.66.3.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the association between low serum vitamin D levels and peripheral arterial disease (PAD). METHODS A cross-sectional study with a consecutive sample of 133 individuals from Caxias do Sul, Brasil. We considered PAD patients those with an ankle-brachial index (ABI) ≤ 0.90 or with arterial revascularization. Vitamin D serum level was categorized as sufficient (≥30 ng/mL), insufficient (>20 to 29 ng/mL), and deficient (<20 ng/mL). Prevalence ratios (RP) were calculated through Poisson regression. RESULTS The prevalence of PAD was 50.7% (95% CI 42-59). After adjustment for potential PAD risk factors, RP were 1.08 (95% CI 0.66-1.76) for insufficient serum level and 1.57 (95% CI 0.96-2.57) for deficient vitamin D serum level; (p for trend = 0.020). CONCLUSION Vitamin D serum levels showed an inverse and significant dose-response relationship with PAD.
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Affiliation(s)
- Simone Bonatto
- . Área do Conhecimento de Ciências da Vida: Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil.,. Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil
| | - Vera Maria Vieira Paniz
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil
| | - Clandio de Freitas Dutra
- . Ambulatório de Cirurgia Vascular, Área do Conhecimento de Ciências da Vida: Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Ruth Liane Henn
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil
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Vitamin D as A Protector of Arterial Health: Potential Role in Peripheral Arterial Disease Formation. Int J Mol Sci 2019; 20:ijms20194907. [PMID: 31623356 PMCID: PMC6801787 DOI: 10.3390/ijms20194907] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 12/14/2022] Open
Abstract
Atherosclerotic occlusive diseases and aneurysms that affect large and medium-sized arteries outside the cardiac and cerebral circulation are collectively known as peripheral arterial disease (PAD). With a rise in the rate of aging population worldwide, the number of people diagnosed with PAD is rapidly increasing. The micronutrient vitamin D is an important steroid hormone that acts on many crucial cellular mechanisms. Experimental studies suggest that optimal levels of vitamin D have beneficial effects on the heart and blood vessels; however, high vitamin D concentrations have been implicated in promoting vascular calcification and arterial stiffness. Observations from various clinical studies shows that deficiency of vitamin D has been associated with a greater risk of PAD. Epidemiological studies have often reported an inverse relation between circulating vitamin D status measured in terms of 25-hydroxivitamin D [25(OH)D] levels and increased cardiovascular disease risk; however, randomized controlled trials did not show a consistent positive effect of vitamin D supplementation on cardiovascular disease risk or events. Even though PAD shares all the major risk factors with cardiovascular diseases, the effect of vitamin D deficiency in PAD is not clear. Current evidence suggests a strong role of vitamin D in promoting genomic and epigenomic changes. This review summarises the current literature that supports the notion that vitamin D deficiency may promote PAD formation. A better understanding of underlying pathological mechanisms will open up new therapeutic possibilities which is the main unmet need in PAD management. Furthermore, epigenetic evidence shows that a more holistic approach towards PAD prevention that incorporates a healthy lifestyle, adequate exercise and optimal nutrition may be more effective in protecting the genome and maintaining a healthy vasculature.
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Yuan J, Jia P, Hua L, Xin Z, Yang JK. Vitamin D deficiency is associated with risk of developing peripheral arterial disease in type 2 diabetic patients. BMC Cardiovasc Disord 2019; 19:145. [PMID: 31208330 PMCID: PMC6580529 DOI: 10.1186/s12872-019-1125-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/02/2019] [Indexed: 12/26/2022] Open
Abstract
Background The relationship between vitamin D levels and peripheral arterial disease (PAD) remains unclear. We assessed the association of serum 25-hydroxyvitamin D (25(OH)D) levels with the prevalence of PAD in patients with type 2 diabetes mellitus(T2DM). Methods A total of 1018 T2DM patients participated in this cross-sectional study. Serum 25(OH)D levels were measured and risk factors of PAD were recorded. PAD was diagnosed as an ankle-brachial index (ABI) < 0.9. Results The mean age of the diabetic patients was 58.59 ± 11.34 years. Of all the patients, only 20.1% had a 25(OH)D level ≥ 20 ng/mL. Compared to patients without PAD, serum 25(OH)D levels were significantly lower in those with PAD (14.81 ± 8.43 vs. 11.55 ± 5.65 ng/mL, P < 0.001). The overall prevalence of PAD was 7.7%. From the highest level (≥ 20 ng/mL) to the lowest level (< 10 ng/mL) of serum 25(OH)D, the prevalence of PAD was 2.8, 7.5 and 10.7% respectively. After adjustment for age, sex, body mass index (BMI), smoking status and season, compared to patients with serum 25(OH)D levels ≥20 ng/mL, the odds ratios of PAD in patients with a level of 10 to < 20 ng/mL and < 10 ng/mL was 3.587(95% CI: 1.314–9.790) and 5.540(95% CI: 2.004–15.320), respectively. When further considering the influence of coronary heart disease (CHD), hypertension and cerebral infarction, the ratios changed to 3.824(95% CI: 1.378–10.615) and 5.729(95% CI: 2.028–16.187), respectively. And after further adjustment for the duration of diabetes, glycated hemoglobin (HbA1c) and glomerular filtration rate (GFR), the ratios changed to 3.489(95% CI: 1.100–11.062) and 3.872(95% CI: 1.168–12.841), respectively. Conclusions Reduced serum vitamin D levels were associated with an increased risk of PAD in T2DM patients. Randomized interventive clinical studies are required to verify the effects of vitamin D supplementation on PAD.
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Affiliation(s)
- Jing Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - Pu Jia
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Lin Hua
- Department of Mathematics, School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Zhong Xin
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Beijing, 100730, China.
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Norouzi H, Ziaie N, Saravi M, Norouzi A, Noei-Teymoordash S, Jokar-Darzi F, Norouzi F, Rajabi-Fumashi M, Zahedi-Tajrishi F, Norouzi S. Association of vitamin D deficiency and premature coronary artery disease. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:80-85. [PMID: 30858945 PMCID: PMC6386332 DOI: 10.22088/cjim.10.1.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Evidence suggests hypovitaminosis D is associated with increased risk of coronary artery disease (CAD) and its extent and related risk factors. However, some investigations have produced contrary results. Therefore, we aimed to evaluate the association between serum vitamin D levels and the severity of premature coronary artery involvement. Methods: This randomized prospective, case-control study was conducted in Babol from April 2013 to June 2017. We collected the demographic data and measured serum 25-OH-D levels of 294 patients (age≤50 years) diagnosed with CAD with coronary angiography as case group as well as 438 age and sex-matched controls. CAD severity was assessed using the Gensini score. Statistical analyses were used to assess the associations and p<0.05 was considered as significant. Results: The mean serum level of 25-OH-D was 13.12±11.13 and 18.28±8.34 in case and control groups, respectively (P=0.036). In the case group, mean serum vitamin D levels were significantly lower among hypertensives (P=0.018), those with a family history of CVD (P=0.016) and those who used aspirin (P=0.036). The mean Gensini score of patients in the case group was 45.02±23.62 and was higher among men (P=0.022). There was a weak significant correlation between the serum vitamin D levels and the Gensini score (P=0.001 & R=-0.543). The mean Gensini score was not significantly different between patients with deficient (47.02±22.78), insufficient (26.0±21.72) and sufficient (39.0±43.84) vitamin D levels (P>0.05). Conclusion: The results showed that the lower levels of vitamin D is associated with increased risk and extent of coronary artery involvement as well as some of the risk factors of CAD, including male gender, hypertension and positive family history for CVD.
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Affiliation(s)
- Hamidreza Norouzi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Naghmeh Ziaie
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | - Mehrdad Saravi
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | - Alireza Norouzi
- Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Fazilat Jokar-Darzi
- Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Fateme Norouzi
- Department of Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maede Rajabi-Fumashi
- Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Farbod Zahedi-Tajrishi
- Student Research Committee, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Shahram Norouzi
- Department of Pediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Apostolakis M, Armeni E, Bakas P, Lambrinoudaki I. Vitamin D and cardiovascular disease. Maturitas 2018; 115:1-22. [PMID: 30049340 DOI: 10.1016/j.maturitas.2018.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/22/2018] [Accepted: 05/30/2018] [Indexed: 02/01/2023]
Abstract
Vitamin D, a soluble steroid hormone synthesized in the skin after sun exposure, plays a crucial role in calcium metabolism and is also involved in cardiovascular pathophysiology. The aim of this review is to summarize the available evidence (a) on the association between endogenous vitamin D status and cardiovascular disease, and (b) on the effect of vitamin D supplementation on cardiovascular outcomes. Most studies have shown an inverse association between vitamin D levels and cardiovascular outcomes. Randomized controlled trials, however, do not consistently support a beneficial effect of vitamin D administration on cardiovascular health. Population characteristics, comorbid conditions such as diabetes, the overall population prevalence of cardiovascular disease, vitamin D status and the regimen of vitamin D supplementation may account for the conflicting results.
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Affiliation(s)
- Michail Apostolakis
- Menopause Clinic, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Armeni
- Menopause Clinic, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Bakas
- Menopause Clinic, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- Menopause Clinic, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Ling Y, Wang Z, Wu B, Gao X. Association of bone metabolism markers with coronary atherosclerosis and coronary artery disease in postmenopausal women. J Bone Miner Metab 2018. [PMID: 28642975 DOI: 10.1007/s00774-017-0841-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study aimed to evaluate the association of bone metabolism markers with coronary atherosclerosis and coronary artery disease (CAD) in postmenopausal women. Based on the findings of coronary angiography, 111 women with CAD and 116 women without CAD were recruited. Serum calcium, phosphate, parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), osteocalcin, N-terminal propeptide of type I procollagen (P1NP) and C-terminal cross-linked telopeptide of type I collagen (CTX) were measured. The Gensini score was used to assess the severity of coronary atherosclerosis. Compared with women with serum calcium ≤2.29 mmol/L, women with serum calcium >2.29 mmol/L had a 2.63-fold increased risk of CAD after adjusting for multiple cardiovascular risks, PTH and 25OHD [odds ratio (OR) = 2.91, 95% confidence interval (CI) 1.35-6.28]. In the fully adjusted model plus PTH and 25OHD, the risk of CAD increased 1.87-fold with every 1-SD increment of serum calcium (OR = 1.87, 95% CI 1.21-2.88). To further analyze the potential strong confounding effect of albumin, the absolute levels of calcium were replaced by their albumin-corrected values in the regression model. Compared with women with albumin-corrected calcium ≤2.27 mmol/L, women with albumin-corrected calcium >2.27 mmol/L had a 2.36-fold increased risk of CAD in the fully adjusted model plus PTH and 25OHD (OR = 2.36, 95% CI 1.13-4.92). The risk of coronary atherosclerosis as defined by Gensini score >0 increased 1.73-fold with every 1-SD increment of serum calcium in the fully adjusted model plus PTH and 25OHD (OR = 1.73, 95% CI 1.09-2.73). However, albumin-corrected calcium was not associated with coronary atherosclerosis either as a categorical variable or as a continuous variable in all models. No significant association of PTH, 25OHD, osteocalcin, CTX and P1NP with CAD or coronary atherosclerosis was found in this study. Higher serum calcium levels were independently associated with CAD in postmenopausal women.
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Affiliation(s)
- Yan Ling
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Zhen Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Bingjie Wu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University and Institute of Chronic Metabolic Diseases of Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
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Iannuzzo G, Forte F, Lupoli R, Di Minno MND. Association of Vitamin D deficiency with peripheral arterial disease: a meta-analysis of literature studies. J Clin Endocrinol Metab 2018; 103:4951505. [PMID: 29590347 DOI: 10.1210/jc.2018-00136] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/19/2018] [Indexed: 02/04/2023]
Abstract
CONTEXT Vitamin D deficiency patients have an increased cardiovascular (CV) morbidity and mortality. Contrasting data are available about the association between peripheral arterial disease (PAD) and Vitamin D status. OBJECTIVE To perform a meta-analysis of studies evaluating the association between Vitamin D status and PAD. DATA SOURCES Studies were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. RESULTS Ten studies with data on Vitamin D levels in 2,079 PAD patients and 18,233 non-PAD controls and 6 studies on the prevalence of PAD in 23,171 subjects with Vitamin D deficiency (<20 ng/ml), 48,311 subjects with Vitamin D insufficiency (20-30 ng/ml) and 27,910 with normal Vitamin D levels (>30 ng/ml) were included. Compared to controls, PAD patients showed significantly lower Vitamin D levels (MD: -2.24 ng/ml; 95%CI: -3.38, -1.10; p<0.001, I2=86.5%; p<0.001). Moreover, a higher prevalence of PAD was found both in subjects with Vitamin D insufficiency (OR: 1.098, 95%CI: 1.010-1.195, p=0.029, I2: 0%, p=0,600) and in subjects with Vitamin D deficiency (OR: 1.484, 95%CI: 1.348-1.635, p<0.001, I2: 7.65%, p=0,367) compared with controls with normal Vitamin D levels. Sensitivity analyses and the analysis of data on the cumulative risk of PAD according to Vitamin D levels derived from multivariate analysis consistently confirmed results. CONCLUSIONS PAD patients have lower vitamin D levels than controls and both Vitamin D deficiency and Vitamin D insufficiency are significantly associated with PAD. Reduced Vitamin D levels might represent an independent risk factor for PAD and, in turn, for CV events.
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Affiliation(s)
- Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Francesco Forte
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Lupoli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
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Li K, Yang X, Wang L, Chen M, Xu L, Yang X. Interaction Between Vitamin D and Lipoprotein (a) on the Presence and Extent of Coronary Heart Disease. Heart Lung Circ 2017; 26:1079-1084. [DOI: 10.1016/j.hlc.2016.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/13/2016] [Accepted: 11/20/2016] [Indexed: 12/13/2022]
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Oh SH, Kweon SS, Choi JS, Rhee JA, Lee YH, Nam HS, Jeong SK, Park KS, Ryu SY, Choi SW, Shin MH. Association between Vitamin D Status and Risk of Peripheral Arterial Disease: The Dong-gu Study. Chonnam Med J 2016; 52:212-6. [PMID: 27689032 PMCID: PMC5040771 DOI: 10.4068/cmj.2016.52.3.212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 01/29/2023] Open
Abstract
Low levels of vitamin D have been associated with increased cardiovascular disease risk. However, few studies have evaluated the association between vitamin D status and peripheral arterial disease (PAD). We therefore aimed to investigate whether low 25-hydroxyvitamin D (25(OH)D) levels were associated with increased risk of PAD in the Korean population. This cross-sectional study was conducted among 8,960 subjects aged 50 years or older without known myocardial infarction or stroke. PAD was defined by an ankle brachial blood pressure index <0.9. Multivariate logistic regression was used to evaluate the association between serum 25(OH)D levels and risk of PAD. Of the 8,960 subjects, 3.0% had PAD and the age and sex adjusted prevalence of PAD decreased with the increasing 25(OH)D quartile. After adjusting for potential confounders and parathyroid hormones, serum 25(OH)D levels were associated with a significantly decreased risk of PAD (OR for one SD increase, 0.98; 95% CI, 0.95-1.0, P for trend=0.040). Compared with the first 25(OH)D quartile, the odds of PAD were 0.86 (95% CI, 0.62-1.21), 0.67 (95% CI, 0.46-0.97), and 0.71 (95% CI, 0.49-1.04) for the second, third, and fourth quartiles, respectively. In this cross-sectional study, we found that low serum 25(OH)D levels were associated with an increased risk of PAD, independent of traditional cardiovascular risk factors and parathyroid hormone. Our findings suggest that low vitamin D levels may contribute to PAD in the Korean population.
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Affiliation(s)
- Su-Hyun Oh
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea.; Jeonnam Regional Cancer Center, Chonnam National University, Hwasun Hospital, Hwasun, Korea
| | - Jin-Su Choi
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jung-Ae Rhee
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Hae-Sung Nam
- Department of Preventive Medicine, Chungnam National University Medical School, Daejeon, Korea
| | - Seul-Ki Jeong
- Department of Neurology & Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Kyeong-Soo Park
- Department of Preventive Medicine, Seonam University College of Medicine, Namwon, Korea
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Seong-Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
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Li K, Yang X, Wang L, Chen M, Zhao W, Xu L, Yang X. Modification of the association between smoking status and severity of coronary stenosis by vitamin D in patients suspected of coronary heart disease. Medicine (Baltimore) 2016; 95:e4817. [PMID: 27603397 PMCID: PMC5023920 DOI: 10.1097/md.0000000000004817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Given both smoking and vitamin D are associated with coronary heart disease (CHD) via inflammation and smoking may interfere with the local antiinflammatory effects of vitamin D. We hypothesized that the relationship between smoking and severity of CHD may be modified by vitamin D.A cross-sectional study was conducted. 25-OH vitamin D values were determined in 348 consecutive patients (mean age 62.4 ± 10.5 years; 56.3% male) undergoing coronary angiography at the Heart Center of Chaoyang Hospital affiliated to Capital Medical University between the period of September 2014 and May 2015. We categorized the patients into 2 groups based on 25-OH vitamin D levels, that is, severe hypovitaminosis D (25-OH vitamin D < 10 ng/mL) and higher vitamin D (25-OH vitamin D > = 10 ng/mL). Multivariable logistic regression models were used to estimate odds ratios (ORs) of severe coronary stenosis or higher Gensini score across three smoking status, that is, never smokers, former smokers, and current smokers in severe hypovitaminosis D and higher vitamin D groups, respectively.Of these patients, we identified 212 (60.9%) cases of severe CHD and 161 (46.3%) cases of severe hypovitaminosis D. Multivariable logistic regression model showed the ORs of severe CHD were 1.94 (95% confidence interval [CI]: 0.47, 7.98) for former smokers and 2.62 (95% CI: 0.83, 8.24) for current smokers, compared with never smokers in group with severe hypovitaminosis D (P-trend = 0.005). In contrast, smoking was not found to be significantly associated with severe CHD in group with higher 25-OH vitamin D (P-trend = 0.115). We found a significant interaction between smoking status and vitamin D on presence of severe CHD (P-interaction = 0.015). In terms of Gensini score as a dependent variable, similar results were identified.Our finding indicated the association between smoking and severity of CHD appeared to be substantially stronger among patients with severe hypovitaminosis D as compared with those with higher vitamin D levels. This suggests vitamin D sufficiency may have a protective effect against the damaging effects of smoking on coronary artery. Future cohort studies are warranted to confirm this finding.
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Affiliation(s)
| | | | | | | | | | | | - Xinchun Yang
- Heart Center of Beijing Chaoyang Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China
- Correspondence: Xinchun Yang, Heart Center of Chaoyang Hospital Affiliated to Capital Medical University, Beijing City, Beijing 100020, China (e-mail: )
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Dhibar DP, Sharma YP, Bhadada SK, Sachdeva N, Sahu KK. Association of Vitamin D Deficiency with Coronary Artery Disease. J Clin Diagn Res 2016; 10:OC24-OC28. [PMID: 27790488 DOI: 10.7860/jcdr/2016/22718.8526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Coronary Artery Disease (CAD) is a major global health problem. Recent studies demonstrated that lower vitamin D level (<30ng/ml) is associated with higher blood pressure and directly or indirectly with CAD, due to vascular endothelial damage. However the results are inconsistent. AIM To find the association of vitamin D deficiency with CAD. MATERIALS AND METHODS In this cross-sectional observational study, serum vitamin D level was measured in 315 patients who underwent coronary angiography. RESULT The mean (±SD) vitamin D was 13.40ng/ml (±10.40). However, the patients with normal coronary artery had much lower mean vitamin D (11.30ng/ml±9.50) as compared to the patients with CAD (14.10ng/ml±10.70). The mean (±SD) vitamin D levels were 19.00ng/ml (±16.50), 14.10ng/ml (±11.10) and 13.20ng/ml (±8.80) in patients with CAD with 50%-70%, >70%-90% and >90% stenosis respectively (p= 0.46) and 15.20ng/ml (±13.00), 15.50ng/ml (±11.30) and 11.80ng/ml (±7.00) in patients with CAD with single, double and triple vessels disease respectively (p= 0.14). The frequency of vitamin D deficiency were 66.70%, 83.20 % and 83.10% in patients with CAD with 50% -70%, >70%-90% and >90% stenosis respectively and 81.40%, 80.00% and 83.50% in patients with single, double and triple vessel disease respectively, as compared to 89.30% in patients with normal coronary artery (p= 0.41 and 0.075). So, all the study groups of CAD had low serum vitamin D level and high frequency of vitamin D deficiency, which was statistically insignificant. CONCLUSION Prevalence of vitamin D deficiency is very high in CAD, but it does not correlate with the angiographic severity of CAD.
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Affiliation(s)
- Deba Prasad Dhibar
- Senior Resident, Department of Internal Medicine, PGIMER , Chandigarh, India
| | - Yash Paul Sharma
- Professor & Head, Department of Cardiology, PGIMER , Chandigarh, India
| | | | - Naresh Sachdeva
- Associate Professor, Department of Endocrinology, PGIMER , Chandigarh, India
| | - Kamal Kant Sahu
- Senior Resident, Department of Internal Medicine, PGIMER , Chandigarh, India
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Cerit L, Kemal H, Gulsen K, Ozcem B, Cerit Z, Duygu H. Relationship between Vitamin D and the development of atrial fibrillation after on-pump coronary artery bypass graft surgery. Cardiovasc J Afr 2016; 28:104-107. [PMID: 27701486 PMCID: PMC5488049 DOI: 10.5830/cvja-2016-064] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/18/2016] [Indexed: 12/14/2022] Open
Abstract
Background: Vitamin D deficiency is associated with many diverse cardiovascular disorders, such as hypertension, heart failure, stroke, coronary artery disease and atrial fibrillation. The relationship between Vitamin D and the development of atrial fibrillation after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between Vitamin D and the development of postoperative atrial fibrillation (POAF) after CABG. Methods: Medical records of consecutive patients who underwent CABG surgery were retrospectively reviewed for the development of atrial fibrillation in the postoperative period. Vitamin D, other biochemical parameters, and clinical and echocardiographic parameters were evaluated in all patients. The independent variables for the development of postoperative atrial fibrillation were defined and their predictive values were measured. Results: The study group consisted of 128 patients, of whom 41 (32%) developed POAF. Age, diabetes mellitus, chronic obstructive pulmonary disease, history of transient ischaemic attack/stroke, heart failure, left atrial diameter, platelet:largecell ratio, and creatinine, urea, uric acid, calcium and potassium levels were identified as important variables for the development of POAF. However, with logistic regression analysis, chronic obstructive pulmonary disease (OR: 28.737, 95% CI: 0.836–16.118, p < 0.001), heart failure (OR: 15.430, 95% CI: 0.989–7.649, p = 0.006), diabetes mellitus (OR: 11.486, 95% CI: 0.734–11.060, p = 0.001) and left atrial diameter (OR: 1.245, 95% CI: 0.086–6.431, p = 0.011) appeared as independent variables predicting the development of POAF. Conclusion: In our study, although there was a significant negative correlation between Vitamin D and left atrial diameter, Vitamin D level was not an independent predictor for POAF.
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Sagarad SV, Sukhani N, Machanur B, Patil S. Effect of Vitamin D on Anginal Episodes in Vitamin D Deficient Patients with Chronic Stable Angina on Medical Management. J Clin Diagn Res 2016; 10:OC24-6. [PMID: 27656481 DOI: 10.7860/jcdr/2016/20521.8345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/23/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Vitamin D deficiency has been found to contribute to various cardiac conditions, such as hypertension, coronary artery disease, stroke, and atherosclerosis. However, the clinical cardiovascular benefits after short term supplementation have not been reported. AIM To study the beneficial effect of Vitamin D supplementation on angina episodes in Vitamin D deficient patients with chronic stable angina on medical management. MATERIALS AND METHODS A total of 40 patients were studied with group 1 (20 patients) with low Vitamin D levels and group 2 with normal Vitamin D levels. 60000 IU of Vitamin D supplementation was given every week for 8 weeks in group 1. Frequency of anginal episodes and use of sub-lingual nitrates were compared at base-line and after 8 weeks post supplementation. RESULTS Significant 20% (p <0.05) reduction in anginal episodes and 17.24% (p <0.05) reduction in use of sub-lingual nitrates was noted in group1 after Vitamin D supplementation. The benefits were independent of BP, heart rate and medications, thus, attributing to supplementation. No significant change was noted in group 2. CONCLUSION Cardiovascular patients need to be evaluated for Vitamin D deficiency. Supplementation to correct Vitamin D levels may have additional cardiovascular benefits like reduction in angina episodes.
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Affiliation(s)
- Suresh V Sagarad
- Assistant Professor, Department of Cardiology, Rajiv Gandhi Super Speciality Hospital, Raichur Institute of Medical Sciences , Raichur, Karnataka, India
| | - Neha Sukhani
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences , Raichur, Karnataka, India
| | - Basavaraj Machanur
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences , Raichur, Karnataka, India
| | - Shashidhar Patil
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences , Raichur, Karnataka, India
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Pasqualini L, Ministrini S, Macura A, Marini E, Leli C, Siepi D, Lombardini R, Kararoudi MN, Scarponi AM, Schillaci G, Pirro M, Mannarino E. Increased Bone Resorption: A Possible Pathophysiological Link Between Hypovitaminosis D and Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2016; 52:352-9. [PMID: 27432480 DOI: 10.1016/j.ejvs.2016.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/24/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE/BACKGROUND Vitamin D deficiency has been associated with the prevalence and severity of peripheral arterial disease (PAD); nevertheless, data on bone turnover in patients with PAD is lacking. The present study investigates a possible relationship between the markers of bone turnover and the presence and severity of PAD. METHODS The study examined 143 patients, with a mean ± SD age of 75.3 ± 8.5 years (range 50.0-93.0 years), of both sexes, admitted to a department of internal medicine. All patients underwent ankle brachial index (ABI) assessment by Doppler velocimetry. Serum levels of 25(OH) vitamin D and two markers of bone turnover, C-terminal telopeptide of type I collagen (sCTX) and bone isoenzyme of alkaline phosphatase, were measured. The differences between patients with normal ABI and patients with PAD were analyzed. Pearson and Spearman correlation coefficients were calculated and independent predictors were identified through a stepwise linear regression analysis. Odds ratios were calculated with a logistic regression model. RESULTS Compared with patients with a normal ABI (≥0.90), patients with PAD (ABI < 0.90) presented with significantly lower levels of 25(OH) vitamin D (12.2 ± 9.6 ng/mL vs. 16.7 ± 8.7 ng/mL; p = .006) and a significantly higher concentration of sCTX (1.1 ± 0.7 ng/mL vs. 0.6 ± 0.4 ng/mL; p < .001). There was a positive correlation between ABI and serum concentration of 25 (OH) vitamin D (r = 0.3; p < .001), whereas ABI was inversely correlated with the concentration of sCTX (r = -0.358; p < .001). At logistic regression analysis, age, cigarette smoking, and both vitamin D and sCTX were independent predictors of an ABI < 0.90. CONCLUSION These results support the hypothesis that hypovitaminosis D and increased bone turnover are risk factors for the presence and severity of PAD. Furthermore, the presence of PAD, even if asymptomatic and diagnosed by a reduced ABI, could identify a population at risk for osteoporosis and osteomalacia.
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Affiliation(s)
- L Pasqualini
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy.
| | - S Ministrini
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - A Macura
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - E Marini
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - C Leli
- Department of Experimental Medicine, Division of Microbiology, University of Perugia, Perugia, Italy
| | - D Siepi
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - R Lombardini
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - M N Kararoudi
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - A M Scarponi
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - G Schillaci
- Department of Medicine, Division of Internal Medicine, University of Perugia, Terni, Italy
| | - M Pirro
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
| | - E Mannarino
- Department of Medicine, Division of Internal Medicine, University of Perugia, Perugia, Italy
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Li DM, Zhang Y, Li Q, Xu XH, Ding B, Ma JH. Low 25-Hydroxyvitamin D Level Is Associated with Peripheral Arterial Disease in Type 2 Diabetes Patients. Arch Med Res 2016; 47:49-54. [PMID: 26854799 DOI: 10.1016/j.arcmed.2016.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patients with type 2 diabetes have an increased risk of atherosclerosis and vascular disease. Vitamin D deficiency is associated with vascular disease and is prevalent in diabetes patients. We undertook this study to determine the association between 25-hydroxyvitamin D (25[OH]D) levels and prevalence of peripheral arterial disease (PAD) in type 2 diabetes patients. METHODS A total of 1028 type 2 diabetes patients were recruited at Nanjing Medical University Affiliated Nanjing Hospital from November 2011 to October 2013. PAD was defined as an ankle-brachial index (ABI) < 0.9. Cardiovascular risk factors (blood pressure, HbA1c, lipid profile), comorbidities, carotid intima-media thickness (IMT) and 25(OH)D were assessed. RESULTS Overall prevalence of PAD and of decreased 25(OH)D (<30 ng/mL) were 20.1% (207/1028) and 54.6% (561/1028), respectively. PAD prevalence was higher in participants with decreased (23.9%) than in those with normal (15.6%) 25(OH)D (≥30 ng/mL, p <0.01). Decreased 25(OH)D was associated with increased risk of PAD (odds ratio [OR], 1.69, 95% CI: 1.17-2.44, p <0.001) and PAD was significantly more likely to occur in participants ≥65 years of age (OR, 2.56, 95% CI: 1.51 -4.48, vs. 1.21, 95% CI: 0.80-1.83, p-interaction = 0.027). After adjusting for known cardiovascular risk factors and potential confounding variables, the association of decreased 25(OH)D and PAD remained significant in patients <65 years of age (OR, 1.55; 95% CI: 1.14-2.12, p = 0.006). CONCLUSIONS Low serum 25(OH)D levels were significantly associated with a higher prevalence of PAD in type 2 diabetes patients <65 years of age. It may increase the risk of PAD independent of other known cardiovascular risk factors.
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Affiliation(s)
- Dong-mei Li
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing Hospital (Nanjing First Hospital), Nanjing, China.
| | - Ying Zhang
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing Hospital (Nanjing First Hospital), Nanjing, China
| | - Qian Li
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing Hospital (Nanjing First Hospital), Nanjing, China
| | - Xiao-hua Xu
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing Hospital (Nanjing First Hospital), Nanjing, China
| | - Bo Ding
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing Hospital (Nanjing First Hospital), Nanjing, China
| | - Jian-hua Ma
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing Hospital (Nanjing First Hospital), Nanjing, China.
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The Role of Vitamin D in Diabetes and Cardiovascular Disease: An Updated Review of the Literature. DISEASE MARKERS 2015; 2015:580474. [PMID: 26576069 PMCID: PMC4630385 DOI: 10.1155/2015/580474] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
The dietary reference values for Vitamin D were set primarily considering its role in bone health, but with the discovery of Vitamin D receptors throughout body tissues, new links with other health conditions are now studied, such as for diabetes and cardiovascular diseases (CVD). This paper shall analyze and examine all new research studies carried out, especially in 2013–2015 regarding diabetes mellitus (DM) and cardiovascular diseases (CVD). Vast research has been carried out to establish strong relationship between Vitamin D serum levels, supplementation, diabetes, and CVD. However, the results from researches identified in this paper are disputable. Benefits of Vitamin D adequate levels were recognized from gestational period until later in disease development such as diabetes and/or CVD, but since not all studies are in agreement further investigation is suggested. Researches conducting large randomized controlled trials, exploring range of supplement doses, with variable baseline serum Vitamin D levels, and inclusion of array of associated parameters, are still required to conduct large-scale analysis and draw conclusion as a risk factor. Until then it is possible to conclude that maintenance of serum Vitamin D levels holds advantageous aspects in diabetic and cardiovascular conditions, and people should strive to attain them.
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Nsengiyumva V, Fernando ME, Moxon JV, Krishna SM, Pinchbeck J, Omer SM, Morris DR, Jones RE, Moran CS, Seto SW, Golledge J. The association of circulating 25-hydroxyvitamin D concentration with peripheral arterial disease: A meta-analysis of observational studies. Atherosclerosis 2015; 243:645-51. [PMID: 26554715 DOI: 10.1016/j.atherosclerosis.2015.10.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/15/2015] [Accepted: 10/05/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS The association of vitamin D deficiency with cardiovascular disease is controversial. The present meta-analysis was performed to examine if circulating levels of 25-hydroxyvitamin D [25(OH)D] were lower in patients with peripheral artery disease (PAD) when compared to non-PAD controls. METHODS A comprehensive database search was conducted in Web of science, Scopus, PubMed, EMBASE and The Cochrane Library to identify observational studies reporting 25(OH)D concentrations in PAD patients and non-PAD participants. Data extraction and study quality assessments were conducted independently. A random-effects model was used to meta-analyse extracted data and generate standardized mean differences (SMDs) in circulating 25(OH)D levels between PAD patients and non-PAD controls. Subgroup analyses were conducted focussing on patients presenting with intermittent claudication (IC) and critical limb ischaemia (CLI). RESULTS Six case-control studies assessing 6418 individuals fulfilled the inclusion criteria. Two studies were considered to be of moderate methodological quality and four were considered to be of high quality. A meta-analysis of data from 1217 PAD patients and 5201 non-PAD participants showed that circulating 25(OH)D concentrations were lower in PAD patients compared with non-PAD participants (SMD = -0.32, 95% CI: -0.58, -0.05; P = 0.02). Subgroup analyses showed that 25(OH)D levels were significantly lower among PAD patients with CLI, but not IC, when compared to non-PAD controls (SMD = -1.29, 95% CI: -1.66, -0.91; P < 0.001 and SMD = -0.01, 95% CI: -0.15, 0.13; P=0.88, respectively). CONCLUSIONS This meta-analysis suggests that low levels of circulating 25(OH)D are associated with PAD presence, particularly in patients presenting with CLI. These data suggest the possibility that vitamin D insufficiency may contribute to the development of more advanced PAD although this remains to be confirmed.
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Affiliation(s)
- Vianne Nsengiyumva
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| | - Malindu E Fernando
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| | - Joseph V Moxon
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| | - Smriti M Krishna
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| | - Jenna Pinchbeck
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| | - Safraz M Omer
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| | - Dylan R Morris
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| | - Rhondda E Jones
- Division of Medicine, Health and Molecular Sciences, James Cook University, Townsville, QLD, Australia
| | - Corey S Moran
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| | - Sai W Seto
- National Institute of Complementary Medicine (NICM), Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Jonathan Golledge
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.
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Optimal Vitamin D Supplementation Levels for Cardiovascular Disease Protection. DISEASE MARKERS 2015; 2015:864370. [PMID: 26435569 PMCID: PMC4578836 DOI: 10.1155/2015/864370] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/09/2015] [Indexed: 12/16/2022]
Abstract
First described in relation to musculoskeletal disease, there is accumulating data to suggest that vitamin D may play an important role in cardiovascular disease (CVD). In this review we aim to provide an overview of the role of vitamin D status as both a marker of and potentially causative agent of hypertension, coronary artery disease, heart failure, atrial fibrillation, stroke, and peripheral vascular disease. The role of vitamin D levels as a disease marker for all-cause mortality is also discussed. We review the current knowledge gathered from experimental studies, observational studies, randomised controlled trials, and subsequent systematic reviews in order to suggest the optimal vitamin D level for CVD protection.
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Lo Gullo A, Mandraffino G, Bagnato G, Aragona CO, Imbalzano E, D’Ascola A, Rotondo F, Cinquegrani A, Mormina E, Saitta C, Versace AG, Sardo MA, Lo Gullo R, Loddo S, Saitta A. Vitamin D Status in Rheumatoid Arthritis: Inflammation, Arterial Stiffness and Circulating Progenitor Cell Number. PLoS One 2015; 10:e0134602. [PMID: 26241902 PMCID: PMC4524708 DOI: 10.1371/journal.pone.0134602] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/12/2015] [Indexed: 12/11/2022] Open
Abstract
Background and Aims Suboptimal vitamin D status was recently acknowledged as an independent predictor of cardiovascular diseases and all-cause mortality in several clinical settings, and its serum levels are commonly reduced in Rheumatoid Arthritis (RA). Patients affected by RA present accelerated atherosclerosis and increased cardiovascular morbidity and mortality with respect to the general population. In RA, it has been reported an impairment of the number and the activity of circulating proangiogenic haematopoietic cells (PHCs), including CD34+, that may play a role in endothelial homeostasis. The purpose of the study is to investigate the association between vitamin D levels and PHCs, inflammatory markers, and arterial stiffening in patients with RA. Methods and Results CD34+ cells were isolated from 27 RA patients and 41 controls. Vitamin D levels, C-reactive protein (CRP), fibrinogen, pulse wave velocity (PWV), and carotid intima-media thickness (cIMT) were also evaluated. CD34+ count and vitamin D levels were lower in RA patients as compared to controls, while fibrinogen, CRP, PWV and cIMT were higher in RA patients. CD34+ cell number appeared to be associated with vitamin D levels, and negatively correlated to fibrinogen and early atherosclerosis markers (PWV and cIMT); vitamin D levels appear also to be inversely associated to fibrinogen. Conclusions RA patients with moderate disease activity presented with low vitamin D levels, low CD34+ cell count, increased PWV and cIMT; we found that vitamin D deficiency is associated to CD34+ cell reduction in peripheral blood, and with fibrinogen levels. This suggests that vitamin D might contribute to endothelial homeostasis in patients with RA.
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Affiliation(s)
- Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- * E-mail:
| | - Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Angela D’Ascola
- Department of Biochemical, Physiological and Nutritional Sciences, University of Messina, Messina, Italy
| | - Francesco Rotondo
- Department of General Surgery and Oncology, University of Messina, Messina, Italy
| | - Antonella Cinquegrani
- Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Carlo Saitta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Maria Adriana Sardo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Renato Lo Gullo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Saverio Loddo
- Department of Biochemical, Physiological and Nutritional Sciences, University of Messina, Messina, Italy
| | - Antonino Saitta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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