Contribution of vitamin D deficiency to the risk of coronary heart disease in subjects with essential hypertension - Jan 2016
Atherosclerosis, Vol 244, January 2016, Pages 165–171
Arash Aghajani Nargesi , Behnam Heidari , Sadaf Esteghamati , Nima Hafezi-Nejad , Sara Sheikhbahaei , Atieh Pajouhi , Manouchehr Nakhjavani , Alireza Esteghamati,
Background: Vitamin D deficiency is proposed as a risk factor for coronary heart disease (CHD). An inverse relation was observed between serum 25-Hydroxy-Vitamin-D level and incidence of hypertension. This study aimed to evaluate the predictive value of serum 25-Hydroxy-Vitamin-D in improvement of CHD risk-stratification in patients with hypertension.
Methods: In this cohort, we followed 1586 patients with essential hypertension (1078 diabetic and 508 non-diabetic) for 8.5 years. Physician-adjudicated first hard CHD event was the primary outcome. Cox regression analysis was used to investigate the association between 25-Hydroxy-Vitamin-D quartiles and incident CHD. 25-Hydroxy-Vitamin-D was also added to the Framingham Risk Score (FRS) and Net-Reclassification-Improvement (NRI) and Integrated-Discriminant-Improvement (IDI) were used to examine improved reclassification.
Results: During follow-up, 176 events were recorded. Patients in the lowest quartile of 25-Hydroxy-Vitamin-D experienced the most number of hard CHD events. A significant linear trend was observed in hazard ratios (HR) of incident hard CHD events in 25-Hydroxy-Vitamin-D quartiles which remained significant after multiple adjustments for conventional CHD risk-factors (HRs in full-adjusted model:
- 2.87 [1.76–4.70] for 1st quartile,
- 2.31 [1.39–3.83] for 2nd quartile and
- 1.87 [1.15–3.03] for 3rd quartile,
compared with the highest quartile; p-for-trend<0.001).
Addition of 25-Hydroxy-Vitamin-D to FRS could improve CHD risk-estimation (relative-IDI = 15%, p-value<0.001). Addition of 25-Hydroxy-Vitamin-D to FRS successfully reclassified 33% [18–49] of patients with hypertension among CHD risk groups (p-value<0.001).
Conclusion: We observed that serum 25-Hydroxy-Vitamin-D is independently associated with future hard CHD events and improves its prediction in patients with essential hypertension. Addition of serum 25-Hydroxy-Vitamin-D to CHD risk-estimation models may have additive values.
Effect modification of hypertension on the association of vitamin D deficiency with severity of coronary stenosis.
Blood Press. 2017 Dec 18:1-7. doi: 10.1080/08037051.2017.1416951. [Epub ahead of print]
Li K1, Zhao W1, Wang L1, Yang X1, Yang X1.
There may exist an effect modification of hypertension on the relation of vitamin D deficiency with cardiovascular disease. The aim of this study was to investigate this interaction on coronary heart disease.
We investigated 348 consecutive patients (mean age 62.4 ± 10.5 years; 56.3% male) who underwent coronary angiography because of chest discomfort at our heart center. Serum 25-OH vitamin D was also detected by ELISA method in these patients. Multivariable logistic regression models were used to estimate odd ratios (ORs) of CHD across vitamin D levels in hypertensives and normotensives, respectively.
We found the multivariable-adjusted ORs of CHD in the bottom(≤8.5 ng/ml) and middle tertiles (8.5-13 ng/ml) of 25-OH vitamin D were 2.86 (95% confidence interval [CI]: 1.38, 5.92) and 1.63 (0.83, 3.20), respectively, compared with those in top tertiles (>13ng/ml) among hypertensives (Ptrend=0.005). In contrast, the corresponding ORs of the above two groups were 0.88 (0.28, 2.74) and 1.23 (0.42, 4.00), respectively, in the normotensives (Ptrend = 0.800; Peffect modification = 0.020). The multivariable-adjusted OR of CHD in patients with severe hypovitaminosis D (<10 ng/ml) versus those with higher vitamin D (≧10 ng/ml) was also greater in hypertensives (2.76; 95% CI: 1.51, 5.04) than that in normotensives (0.92; 95% CI: 0.37, 2.33; Peffect modification=0.013). Similar results were observed when Gensini Score was treated as a dependent variable.
Our finding suggests the presence of hypertension may modify the association of vitamin D deficiency with severity of coronary stenosis.
PMID: 29254371 DOI: 10.1080/08037051.2017.1416951
It both categories of Hypertension and Cardiovascular
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The TOP articles in Hypertension and Vitamin D are listed here:
Far fewer heart problems for those with hypertension if they have > 15 ng of vitamin D
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