Vitamin D status and the risk of major adverse cardiac and cerebrovascular events in cardiac surgery
Eur Heart J (2013) doi: 10.1093/eurheartj/ehs468 First published online: January 12, 2013
Armin Zittermann 1,*; Joachim Kuhn 2; Jens Dreier 2; Cornelius Knabbe 2; Jan F. Gummert 1; Jochen Börgermann 1
1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstrasse 11, Bad Oeynhausen, Germany
2 Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstrasse 11, Bad Oeynhausen, Germany
↵*Corresponding author. Tel: +49 5731 97 1912, Fax: +49 5731 97 2020, Email: azittermann@hdz-nrw.de
Aims A significant proportion of cardiac surgical patients develop critical post-operative complications. We aimed to investigate the association of pre-operative 25-hydroxyvitamin D (25(OH)D) levels with major cardiac and cerebrovascular events (MACCE) in cardiac surgical patients.
Methods and results From January 2010 to August 2011, we consecutively measured circulating 25(OH)D in 4418 operated patients.
Of the study cohort, 38.0% had deficient 25(OH)D values (<30 nmol/L) and additional 32.3% had insufficient values (30–49.9 nmol/L), whereas only 3.1% had values >100 nmol/L.
The incidence of MACCE was 11.5%. In multivariable-adjusted logistic regression models, the odds ratio of MACCE at deficient, inadequate, and high 25(OH)D levels was 2.23 [95% confidence interval (CI): 1.31–3.79], 1.73 (95% CI: 1.01–2.96) and 2.34 (95% CI: 1.12–4.89), respectively, compared with 25(OH)D levels of 75–100 nmol/L.
A U-shaped association with circulating 25(OH)D was also present for duration of mechanical ventilatory support and intensive care unit stay.
Multivariable-adjusted 6- and 12-month mortality were higher in patients with deficient 25(OH)D levels compared with patients with 25(OH)D levels of 75–100 nmol/L.
Conclusion Deficient 25(OH)D levels are prevalent in cardiac surgical patients in Central Europe and are independently associated with the risk of MACCE. Further research should clarify the potential of vitamin D supplements in reducing cardiovascular risk in vitamin D-deficient patients and also the mechanisms leading to adverse effects on the cardiovascular system in the small group of patients with 25(OH)D levels >100 nmol/L.
Trial registration information: Clinicaltrials.gov identifier number: NCT01552382
Summary by VitaminDWiki
- Look at death rate for 1 year after heart surgery (4418 patients)
| Vitamin D Level Before surgery | % with this amount of vitamin D | Death Rate compared to 20-40 ng |
| < 12 ng | 38% | 2.23 |
| 12-20 ng | 32% | 1.73 |
| 20-40 ng | 22% | 1.0 |
| >40 ng | 3% | 2.34 |
Hypothesis 1: Took supplements because not healthy
Most people who have vitamin D levels > 40 ng have been taking supplements.
Many people take supplements because they are not feeling healthy.
Thus those who died more often after the heart surgery might have been those who had poor health prior to the surgery.
Hypothesis 2: Vitamin D levels dropped a lot after surgery
Serum levels of Vitamin D are known to drop dramatically after surgery/trauma.
Individuals with the higher vitamin D levels prior to surgery may have dropped much more than those with lower levels.
The post-surgery dramatic drop from high level, if not compensated for with increased sunshine, UVB, or supplements, may have put those with high levels of vitamin D at risk.
Hypothesis 3: Vitamin A blocked the benefits of vitamin D in the blood
Vitamin A may thwart the ability of vitamin D to reduce risk of osteoporosis – June 2010
Vitamin D protects against lung cancer unless there is excess vitamin A – July 2012
Hypothesis 4: Vitamin D increased or decreased the benefit of the drugs being taken
Other U-shaped association of vitamin D in VitaminDWiki
- Search of all U-Shaped and Mortality 277 hits as of Dec 2013
- Mortality increased with highest levels of vitamin D – article and 4 letters Aug 2012
- 50 percent more elderly deaths when vitamin D under 18 ng or over 40 ng – Aug 2010
- Is 50 ng of vitamin D too high, just right, or not enough has a section on U-Shaped responses
- Is High Dose Vitamin D Harmful – Dec 2012
- Vitamin D and Pancreatic Cancer Risk - No U-Shaped Curve - Mar 2012
- Frailty and vitamin D – U shaped curve – Dec 2010
- Is too much vitamin D bad – possible causes and cures
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