Vitamin D Levels for Preventing Acute Coronary Syndrome and Mortality: Evidence of a Non-Linear Association
The Journal of Clinical Endocrinology & Metabolism March 26, 2013 jc.2013-1185
Yosef Dror, PhD*,
Shmuel Giveon, MD, MPH.*,
Moshe Hoshen, PhD.,
Ilan Feldhamer, MA.,
Ran Balicer, MD, PhD, MPH. and
Becca Feldman, PhD
Yosef Dror PhD*, School of Nutrition, Faculty of Agriculture, The Hebrew University of Jerusalem, Rehovot, Israel. Clalit Research Institute and Chief Physician Office, Clalit Health Services, Israel; Shmuel Giveon MD,
MPH*. Department of Family Practice, Sharon-Shomron District, Clalit Health Services, Israel; Department of Family Practice, Sackler School of Medicine, Tel-Aviv University, Israel; Moshe Hoshen PhD. Clalit Research Institute and Chief Physician Office, Clalit Health Services, Israel; Ilan Feldhamer MA. Department of Research and Information, Chief Physician Office, Clalit Health Services, Israel; Ran Balicer MD, PhD, MPH. Clalit Research Institute and Chief Physician Office, Clalit Health Services, Tel-Aviv, Israel; Department of Epidemiology, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Becca Feldman PhD. Clalit Research Institute and Chief Physician Office, Clalit Health Services, Israel.
Address all correspondence and requests for reprints to: Corresponding Author: Yosef Dror PhD, School of Nutrition, Faculty of Agriculture,
The Hebrew University of Jerusalem, Rehovot, Israel (email@example.com), E-mail dror at huji.ac.il Tel 972–8-9489280; Home 972–8-9451364; Mobile 972-547-404978; Fax 972–9-8641322.
↵* Both have equally contributed to the study
Context: Low serum calcidiol has been associated with multiple co-morbidities and mortality but no “safe” range has been found for the upper concentration.
Objective: To establish the upper threshold of serum calcidiol, beyond which there is an increased risk for acute coronary syndrome and/or mortality.
Design, Setting, and Participants: We extracted data for 1,282,822 Clalit Health Services members aged > 45 between July 2007 and December 2011. Records of mortality or acute coronary syndrome were extracted during the follow-up period. Kaplan Meier analysis calculated time to episode and Cox regression models generated adjusted hazard ratios for episode by calcidiol group (< 10, 10.1–20, 20.1–36 and > 36.1 ng/mL).
Outcome Measures: Acute coronary syndrome subsuming all-cause mortality.
Results: During the 54-month study period, 422,822 Clalit Health Services members were tested for calcidiol of which 12,280 died of any cause (905 with acute coronary syndrome) and 3,933 were diagnosed with acute coronary syndrome. Compared to those with 20–36 ng/ml, the adjusted hazard ratios among those with levels of < 10, 10–20 and > 36 ng/ml were 1.88 [CI: 1.80–1.96], 1.25 [CI:1.21–1.30] and 1.13 [CI:1.04–1.22], (P < 0.05) respectively.
Limitations: The study cohort comprised only 30% of the population, those tested for vitamin D.
The small sample size of those with calcidiol > 36 ng/mL prevented further analysis of this group.
Conclusions: Vitamin D in the 20–36 ng/ml range was associated with the lowest risk for mortality and morbidity.
The hazard ratio below and above this range increases significantly.
Received January 20, 2013. Accepted March 18, 2013.
- 2/3 of the population were not tested for vitamin D deficiency – probably because they were nos suspected to have < 36 ng/ml of vitamin D
- They had few people with > 36 ng/ml = “small sample size”, so ‘’ prevented further analysis””
- Yet, they concluded that hazard ratio increased above that range – based on what data?
- Why are doctors reluctant to accept vitamin D
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- Mortality increased with highest levels of vitamin D – article and 4 letters Aug 2012Lacking data, claimed evidence of cardiac probems if too much vitamin D – March 2013
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