Vitamin D Levels Predict All-Cause and Cardiovascular Disease Mortality in Subjects With the Metabolic Syndrome:
Diabetes Care. 2012 May;35(5):1158-64. Epub 2012 Mar 7.
G. Neil Thomas, PHD1,3,
Bríain ó Hartaigh, MPHIL1,2,
Jos A. Bosch, PHD2,3, j.a.bosch at uva.nl
Stefan Pilz, MD3,4,
Adrian Loerbroks, PHD3,
Marcus E. Kleber, PHD3,
Joachim E. Fischer, MD3,
Tanja B. Grammer, MD3,
Bernhard O. Böhm, MD5 and
Winfried März, MD3,6,7
1 Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom
2 School of Sport and Exercise Sciences, University of Birmingham, Birmingham, United Kingdom
3 Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
4 Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
5 Department of Internal Medicine I, Division of Endocrinology and Diabetes, Ulm University, Ulm, Germany
6 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
7 Synlab Services GmbH, Mannheim, Germany
OBJECTIVE Optimal vitamin D levels are associated with reduced cardiovascular and all-cause mortality.
We investigated whether optimal 25-hydroxyvitamin D (25[OH]D) is protective in individuals with the metabolic syndrome.
RESEARCH DESIGN AND METHODS The Ludwigshafen Risk and Cardiovascular Health (LURIC) study is a cohort study of subjects referred for coronary angiography between 1997 and 2000, from which 1,801 with the metabolic syndrome were investigated.
Mortality was tracked for a median of 7.7 years.
Multivariable survival analysis was used to estimate the association between 25(OH)D levels and mortality.
RESULTS Most subjects (92%) had suboptimal levels of 25(OH)D (<75 nmol/L), with 22.2% being severely deficient (<25 nmol/L).
During follow-up, 462 deaths were recorded, 267 (57.8%) of which were cardiovascular in origin.
After full adjustment, including the metabolic syndrome components, those with optimal 25(OH)D levels showed a substantial reduction in
- all-cause (hazard ratio [HR] 0.25 [95% CI 0.13–0.46]) and
- cardiovascular disease mortality (0.33 [0.16–0.66])
compared with those with severe vitamin D deficiency.
For specific cardiovascular disease mortality, there was a strong reduction for
- sudden death (0.15 [0.04–0.63]) and
- congestive heart failure (0.24 [0.06–1.04]),
but not for myocardial infarction.
The reduction in mortality was dose-dependent for each of these causes.
CONCLUSIONS Optimal 25(OH)D levels substantially lowered all-cause and cardiovascular disease mortality in subjects with the metabolic syndrome. These observations call for interventional studies that test whether vitamin D supplementation provides a useful adjunct in reducing mortality in these subjects.
Received September 5, 2011. Accepted January 10, 2012.
© 2012 by the American Diabetes Association.
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