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Vitamin D not associated with PAD after adjusting for race, diabetes and BMI – July 2012

Vitamin D status and functional performance in peripheral artery disease

Vascular Med July 19, 2012
Mary M McDermott mdm608 at northwestern.edu, Department of Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
Kiang Liu. Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
Luigi Ferrucci. Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
Lu Tian, Department of Health and Research Policy, Stanford University, Palo Alto, CA, USA
Jack Guralnik, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
Peter Kopp, Department of Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
Huimin Tao, Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
Linda Van Horn, Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
Yihua Liao. Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
David Green, Department of Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
Melina Kibbe, Department of Surgery, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
Michael Criqui, University of California at San Diego, San Diego, CA, USA

The clinical implications of low vitamin D in peripheral artery disease (PAD) are unknown. We hypothesized that among individuals with PAD, lower levels of 25-hydroxyvitamin D would be associated with poorer functional performance, more adverse calf muscle characteristics, and poorer peripheral nerve function.

Participants were 402 men and women with PAD who underwent measurement of 25-hydroxyvitamin D (DiaSorin radioimmunoassay) along with 6-minute walk testing, measurement of walking velocity at usual and fastest pace, computed tomography-measured calf muscle density, and peripheral nerve conduction velocity (NCV). Among PAD participants, 20.4% had 25-hydroxyvitamin D levels < 30 nmol/L, consistent with deficient vitamin D status.

Adjusting for age, sex, and race, lower 25-hydroxyvitamin D levels were associated with poorer 6-minute walk performance (p trend = 0.002), slower usual-paced 4-meter walking velocity (p trend = 0.031), slower fast-paced 4-meter walking velocity (p trend = 0.043), and lower calf muscle density (p trend = 0.031).

After additional adjustment for body mass index (BMI) and diabetes, none of these associations remained statistically significant.

However, lower levels of 25-hydroxyvitamin D were associated with poorer peroneal NCV (p trend = 0.013) and poorer sural NCV (p trend = 0.039), even after adjusting for age, sex, race, BMI, comorbidities, smoking, physical activity, and other confounders.

In conclusion, vitamin D deficiency is common among people with PAD encountered in clinical settings. After adjusting for BMI and diabetes mellitus, we found no significant associations of lower levels of 25-hydroxyvitamin D with poorer functional performance or calf muscle characteristics. Associations of low vitamin D levels with poorer peripheral nerve function require further study.


VitaminDWiki comment

Vitamin D deficiency in previous studies has been shown to be strongly associated with race, diabetes and high BMI.

So, it is no surprise that after ‘’adjusting’’ for those factors that no other association of PAD to vitamin D remained.

What is surprising was that any association remained – that of nerve conduction velocity, which affects how fast a person can react, say when off-balance.
If the nerves are either

  • too slow to either announce the act of falling
  • or too slow to pass along the command to the muscles to react to the in-balance.

The person will be more likely to fall.
Many studies have found that adequate vitamin D reduces falling.


See also PubMed

  • Vitamin D status, functional decline, and mortality in peripheral artery disease Vascular Medicine Dec 2013
    Among participants with PAD, lower baseline vitamin D levels were associated with a faster decline in the 6-minute walk
      vitamin D < 30 nmol/L: –70.0 feet/year;
      vitamin D 30 to < 50 nmol/L: –72.3 feet/year;
      vitamin D 50 to < 75 nmol/L: –35.5 feet/year;
      vitamin D 75 to < 120 nmol/L: –35.9 feet/year
    no significant associations of baseline vitamin D levels with all-cause or cardiovascular disease mortality
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