Background. Cardiovascular disease is the most common cause of mortality and morbidity in the United States as well as many other nations. Recent evidence supports an association of vitamin D deficiency with hypertension, peripheral vascular disease, diabetes mellitus, metabolic syndrome, coronary artery disease, and heart failure. We wished to study the association of vitamin D deficiency in a cohort of patients followed by a large cardiovascular practice at an academic medical institution, as well as the association of vitamin D replacement with improvement in cardiovascular outcomes.
Methods. Serum vitamin D measurements for 5 years and 8 months (1/1/2004 to 10/8/2009) from The University of Kansas Hospital were obtained. These values were matched to patient demographic, physiologic and disease state variables from the cardiovascular database. Serum vitamin D levels were analyzed as a continuous variable and as normal (>30ng/ml) or deficient. Descriptive statistics, univariate analysis, multivariate analysis, survival analysis, and Cox proportional hazard modeling were performed.
Results. 10,899 patients were available for analysis. Mean age was 58.3 +/- 14.9 years. There were 7758 (71%) women and 3141 (29%) men. Mean weight was 185.7 +/-52.0 lbs and BMI was 29.9 +/- 7.7 Ejection fraction was 57.2 +/- 10.4%. Mean vitamin D was 24.1 +/- 13.6 ng/ml. 3294 (29.7%) subjects were in normal range (.30ng/ml) and 7665 (70.3%) were deficient (<30ng/ml). Vitamin D deficiency was found to be associated with several cardiovascular disease states including hypertension, coronary artery disease and cardiomyopathy; as well as diabetes and death (all P’s < .05). Logistic regression analysis found vitamin D deficiency to be a strong predictor of death (OR 2.64, CI 1.901-3.662, P < .0001). This association persisted with other clinical variables such as, BMI, gender, and ejection fraction added to the model and was confirmed by survival as well as hazard function analysis. Vitamin D replacement conferred substantial survival benefit (OR for death 0.39, CI 0.277-0.534, P < .0001) and was particularly beneficial in vitamin D deficient patients. The interaction of vitamin D deficiency and supplementation was analyzed as well as the association of vitamin D deficiency and certain coronary artery disease risk factors.
Conclusions. Vitamin D deficiency is a significant risk factor for several cardiovascular disease states and is a significant independent predictor of reduced survival. Vitamin D supplementation improves survival with greater benefit in deficient patients. Prospective randomized trials of vitamin D supplementation in patients with cardiovascular diseases are warranted, as well as consideration for increased supplementation in the general public.
Keywords: Vitamin D, Cardiovascular Diseases, Risk Factors
|Advisor:||Choi, Won S.|
|Commitee:||Lai, Sue-Min, Yeh, Hung-Wen (Henry)|
|School:||University of Kansas|
|Department:||Preventive Medicine and Public Health|
|School Location:||United States -- Kansas|
|Source:||MAI 48/06M, Masters Abstracts International|
|Subjects:||Medicine, Public health, Epidemiology|
|Keywords:||Cardiac diseases, Cardiac risk factors, Cardiovascular diseases, Survival, Vitamin D, Vitamin D deficiency|
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