title: Vitamin D levels and asymptomatic coronary artery disease in type 2 diabetic patients with elevated urinary albumin excretion rate.
abstract: OBJECTIVE
  Coronary artery disease (CAD) is the major cause of morbidity and mortality in type 2 diabetic patients. Severe vitamin D deficiency has been shown to predict cardiovascular mortality in type 2 diabetic patients.
  
  
  METHODS
  We investigated the association among severe vitamin D deficiency, coronary calcium score (CCS), and asymptomatic CAD in type 2 diabetic patients with elevated urinary albumin excretion rate (UAER) >30 mg/24 h. This was a cross-sectional study including 200 type 2 diabetic patients without a history of CAD. Severe vitamin D deficiency was defined as plasma 25-hydroxyvitamin D (p-25[OH]D3) <12.5 nmol/L. Patients with plasma N-terminal pro-brain natriuretic peptide >45.2 ng/L or CCS ≥400 were stratified as being high risk for CAD (n= 133). High-risk patients were examined by myocardial perfusion imaging (MPI; n = 109), computed tomography angiography (n = 20), or coronary angiography (CAG; n = 86). Patients' p-25(OH)D3 levels were determined by high-performance liquid chromatography/tandem mass spectrometry.
  
  
  RESULTS
  The median (range) vitamin D level was 36.9 (3.8-118.6) nmol/L. The prevalence of severe vitamin D deficiency was 9.5% (19/200). MPI or CAG demonstrated significant CAD in 70 patients (35%). The prevalence of CCS ≥400 was 34% (68/200). Severe vitamin D deficiency was associated with CCS ≥400 (odds ratio [OR] 4.3, 95% CI [1.5-12.1], P = 0.005). This association persisted after adjusting for risk factors (4.6, 1.5-13.9, P = 0.007). Furthermore, severe vitamin D deficiency was associated with asymptomatic CAD (adjusted OR 2.9, 1.02-7.66, P = 0.047).
  
  
  CONCLUSIONS
  In high-risk type 2 diabetic patients with elevated UAER, low levels of vitamin D are associated with asymptomatic CAD.
authors: Steno Diabetes Center, Gentofte, Denmark. cijq@steno.dk
authors: Christel
authors: C
authors: Joergensen
authors: Henrik
authors: H
authors: Reinhard
authors: Anne
authors: A
authors: Schmedes
authors: Peter R
authors: PR
authors: Hansen
authors: Niels
authors: N
authors: Wiinberg
authors: Claus L
authors: CL
authors: Petersen
authors: Kaj
authors: K
authors: Winther
authors: Hans-Henrik
authors: HH
authors: Parving
authors: Peter K
authors: PK
authors: Jacobsen
authors: Peter
authors: P
authors: Rossing
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000652:urine*; D002112:Calcifediol / Q000097:blood*; D002114:Calcinosis / Q000150:complications; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002112:Calcifediol