Vitamin D Levels Predict All-Cause and Cardiovascular Disease Mortality in Subjects With the Metabolic Syndrome:

The Ludwigshafen Risk and Cardiovascular Health (LURIC) Study

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@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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See also VitaminDWiki

• Metabolic Syndrome and vitamin D
• All items in category Metabolic Syndrome 105 items
• Metabolic Syndrome 70 percent more likely if vitamin D insufficient – March 2012
• Review of Metabolic Syndrome and vitamin D – June 2012