Plasma vitamin D and mortality in older men: a community-based prospective cohort study.
BACKGROUND
Vitamin D status is known to be important for bone health but may also affect the development of several chronic diseases, including cancer and cardiovascular diseases, which are 2 major causes of death.


OBJECTIVE
We aimed to examine how vitamin D status relates to overall and cause-specific mortality.


METHODS
The Uppsala Longitudinal Study of Adult Men, a community-based cohort of elderly men (mean age at baseline: 71 y; n = 1194), was used to investigate the association between plasma 25-hydroxyvitamin D [25(OH)D] and mortality. Total plasma 25(OH)D was determined with HPLC atmospheric pressure chemical ionization mass spectrometry. Proportional hazards regression was used to compute hazard ratios (HRs).


RESULTS
During follow-up (median: 12.7 y), 584 (49%) participants died. There was a U-shaped association between vitamin D concentrations and total mortality. An approximately 50% higher total mortality rate was observed among men in the lowest 10% (<46 nmol/L) and the highest 5% (>98 nmol/L) of plasma 25(OH)D concentrations compared with intermediate concentrations. Cancer mortality was also higher at low plasma concentrations (multivariable-adjusted HR: 2.20; 95% CI: 1.44, 3.38) and at high concentrations (HR: 2.64; 95% CI: 1.46, 4.78). For cardiovascular death, only low (HR: 1.89; 95% CI: 1.21, 2.96) but not high (HR: 1.33; 95% CI: 0.69, 2.54) concentrations indicated higher risk.


CONCLUSIONS
Both high and low concentrations of plasma 25(OH)D are associated with elevated risks of overall and cancer mortality. Low concentrations are associated with cardiovascular mortality.
Michaëlsson
Karl
K
Department of Surgical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. karl.michaelsson@surgsci.uu.se
Baron
John A
JA
Snellman
Greta
G
Gedeborg
Rolf
R
Byberg
Liisa
L
Sundström
Johan
J
Berglund
Lars
L
Arnlöv
Johan
J
Hellman
Per
P
Blomhoff
Rune
R
Wolk
Alicja
A
Garmo
Hans
H
Holmberg
Lars
L
Melhus
Håkan
H
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D004734:Energy Metabolism; D006801:Humans; D007899:Leisure Activities; D008019:Life Style; D008297:Male; D009026:Mortality; D016016:Proportional Hazards Models; D013548:Sweden; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism
D014807:Vitamin D; D002784:Cholesterol; C104450:25-hydroxyvitamin D; D002118:Calcium