Vitamin D status and cardiovascular disease. Observational studies in patients who underwent coronary angiography
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Background: Vitamin D is required to maintain a healthy cardiovascular system, but it is unknown whether variation in vitamin D status in the general population is physiologically relevant to development of cardiovascular diseases (CVDs). Aim: To study vitamin D status and investigate the associations of vitamin D status with atherosclerosis progression, all-cause and CVD mortality. Methods: Observational data from patients in Western-Norway with suspected coronary artery disease were used (n=4116). Vitamin D status was assessed by the measurement of plasma 25-hydroxyvitamin D (25OHD) concentrations, atherosclerosis progression by repeat coronary angiography and survival data obtained from national registries. Results: Mean 25OHD most strongly associated with seasonality, adiposity and cod liver oil consumption. Seasonal variation in 25OHD differed by age. During winter and summer ~50% and ~80% of the participants were vitamin D sufficient, respectively. When modelling baseline values, cosinor models most accurately predicted follow-up values for patients with repeated measurements of 25OHD. Baseline concentrations of 25OHD were not associated with atherosclerosis progression after ~1 year of follow-up, but were inversely associated with a higher risk of all-cause and cardiovascular mortality after ~12 years of follow-up. Despite a linear tendency, non-linearity was observed in the relationship with all-cause mortality, with higher risk among individuals with 25OHD concentrations below 42.5 nmol/l and above 100 nmol/l in comparison to those between 42.5 – 100 nmol/l. Conclusions: Seasonal variation has a strong influence on vitamin D status and researchers should consider cosinor models when adjusting for seasonality. A high frequency of insufficiency during winter indicates inadequate dietary intakes despite a high frequency of cod liver oil use in this population. Vitamin D status was inversely associated with a higher risk of all-cause and CVD mortality, but not associated with subclinical progression of atherosclerosis. The relationship with allcause mortality was J-shaped, with increased risk also among a smaller segment of participants with high 25OHD concentrations.
Består avPaper I: Degerud E, Løland KH, Nygård O, Midttun Ø, Ueland PM, Seifert R, Strand E, Bleie Ø, Dierkes J. Vitamin D status was not associated with ‘one-year’ progression of coronary artery disease, assessed by coronary angiography in statin-treated patients. Eur J Prev Cardiol. 2015;22(5):594-602. The article is not available in BORA due to publisher restrictions. The published version is available at: http://dx.doi.org/10.1177/2047487314522137
Paper II: Degerud E, Hoff R, Nygård O, Strand E, Nilsen DW, Nordrehaug JE, Midttun Ø, Ueland PM, de Vogel S, Dierkes J. Cosinor modelling of seasonal variation in 25-hydroxyvitamin D concentrations in cardiovascular patients in Norway. Eur J Clin Nutr. 2016;70(4):517-522. The article is available at: http://hdl.handle.net/1956/12717
Paper III: Degerud E, Nygård O, de Vogel S, Hoff R, Svingen G, Pedersen ER, Nilsen DW, Nordrehaug JE, Midttun Ø, Ueland PM, Dierkes J. Plasma 25-hydroxyvitamin D concentrations and all-cause and cardiovascular disease mortality among Caucasian patients with suspected stable angina pectoris. Manuscript. The article is not available in BORA.