Association of Vitamin D Deficiency with Coronary Artery Disease

The Impact of Vitamin D Deficiency on Coronary Artery Disease Severity Based on Myocardial Perfusion Imaging: A Cross-Sectional Study

Background

The impact of low levels of vitamin D (Vit D) on the severity of cardiovascular diseases has become a significant challenge. This study aimed to assess this impact.

Methods

This pilot cross-sectional study enrolled two hundred patients referred to Namazi Hospital, Shiraz, Iran for myocardial perfusion imaging in 2019. The assessment included myocardial perfusion imaging and Vit D level evaluation. Quantitative ischemia analysis utilized Estimated Summed Stress Scores (SSS), Summed Rest Scores (SRS), and Summed Difference Scores (SDS). Myocardial Perfusion Imaging (MPI) results were categorized into normal, mild ischemia, moderate ischemia, and severe ischemia based on estimated SSS. Ischemia severity was aligned with established criteria, designating severe quantitative ischemia as SSS>13. Vit D was categorized using cutoffs at 10, 20, and 30 ng/mL. Mann-Whitney U-test was used for quantitative variables and Chi Square test for qualitative variables.

Results

Chi Square test revealed a significant association between categorized Vit D levels below 10 ng/mL and severe ischemia (SSS>13) (P<0.001). Total Vit D level and also categorized Vit D with cut-offs of 10, 20, and 30 ng/mL showed no association with abnormal MPI. SSS was notably higher in patients with Vit D levels below 10 ng/mL (P=0.026).

Conclusion

The findings of this study emphasize an association between Vit D level below 10 ng/mL and severe myocardial ischemia, as indicated by SSS.

S, Seshu A, R. P, M. MP. Correlation of vitamin D level and severity of coronary artery disease

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.

VDBP and VDR Mutations May Cause In-Stent Restenosis

Objective: In-stent restenosis (ISR) is the narrowing of a stented coronary artery lesion. A considerable number of patients undergoing percutaneous coronary intervention (PCI) are affected by ISR. The predominant mechanism in the development of ISR is an inflammatory response to vessel wall injury during PCI. Vitamin D is reported to have anti-inflammatory properties, so it may also be related with ISR. Therefore, in this study the relationship between vitamin D receptor (VDR), vitamin D binding protein (VDBP) gene variations and ISR were investigated. Methods: Fifty-eight ISR patients who have chest pain, underwent angiography and were found to have restenosis in the previously inserted stent were included in the patient group and thirty-five patients who have chest pain and were not found to have restenosis in their previous stent in coronary angiography were included in the control group. rs7041 and rs4588 variations in VDBP; rs1544410 and rs2228570 variations in VDR were investigated by real-time polymerase chain reaction (RT-PCR). Results were evaluated statistically. Results: The CC genotype of rs2228570 variation of VDR and the CA genotype of rs4588 variation of VDBP were found statistically high in patient group. rs7041 variation was found statistically high in patients who had myocardial infarction history before stent implantation. Additionally, it was demonstrated that vitamin D deficiency (vitamin D level

Vitamin D deficiency: concern for rheumatoid arthritis and COVID-19?

Vitamin D is an immunomodulatory hormone with an established role in calcium and phosphate metabolism and skeletal mineralization. Evidence showing its immunological benefits by regulating essential components of the innate and adaptive immune system is prevalent. Vitamin D deficiency is reported worldwide and is thereby found to be associated with various immune-related diseases. Rheumatoid Arthritis and COVID-19 are two such diseases, sharing a similar hyperinflammatory response. Various studies have found an association of lower Vitamin D levels to be associated with both these diseases. However, contrasting data is also reported. We review here the available scientific data on risk factor association and supplementation benefits of Vitamin D in Rheumatoid Arthritis and COVID-19, intending to critically evaluate the literature.

Association of vitamin D deficiency and premature coronary artery disease

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.

Serum Vitamin D Level in Patients with Coronary Artery Disease and Association with Sun Exposure: Experience from a Tertiary Care, Teaching Hospital in India

BACKGROUND

Vitamin D, a fat-soluble vitamin, has various extraskeletal effects, and several human and animal studies have suggested that vitamin D deficiency may be a contributory factor in the pathogenesis of coronary artery disease (CAD). However, such studies in the Indian subcontinent are either lacking or have shown conflicting results.

METHODS

This was a descriptive cross-sectional study involving 121 patients with CAD from a tertiary care center and their 80 age-matched healthy controls. Serum vitamin D levels along with serum and urine chemistries were measured in both the groups. The average duration of sun exposure/day and use of sunscreen were also considered in the study cohort using a questionnaire. Serum vitamin D levels were categorized into deficient (<30 nmol/lit), insufficient (30-75 nmol/lit), and sufficient (>75 nmol/lit) groups.

RESULTS

Among the cases, 51.2% of the patients were vitamin D deficient and 44.6% patients had insufficient vitamin D levels, whereas among controls, 40% and 31% of the population had deficient and insufficient levels of vitamin D, respectively. However, the mean value of the serum vitamin D level was not statistically different in the cases as compared to that of the controls (34.06 vs 40.19 nmol/lit) (P=0.08). Corrected serum calcium (9.26 vs 9.59 mg%) (P ≤ 0.0001) and serum albumin levels (4.21 vs 4.75 gm%) (P ≤ 0.0001) were lower in the cases than those of the controls. The average sun exposure/day was higher among the cases than that among the controls (2.93 vs 1.85 hours) (P=0.001).

CONCLUSION

Vitamin D deficiency is widely prevalent in Indian population despite abundant sunshine, and the duration of sun exposure is not correlated with serum vitamin D levels. Vitamin D deficiency is not associated with CAD. However, serum calcium is deficient in CAD patients as compared to the controls. Large-scale studies are required to explore the association further to evaluate the benefits of screening and correction of vitamin D deficiency in patients with CAD.