title: Association of 25-hydroxyvitamin D deficiency with NT-pro BNP levels in patients with acute myocardial infarction: a cross-sectional analysis.
abstract: BACKGROUND
  Nutritional vitamin D deficiency is an emerging risk factor for acute myocardial infarction (AMI) and heart failure. The association of 25-hydroxyvitamin D levels with N-terminal pro B-type natriuretic peptide (NT-proBNP), a robust prognostic marker for post-AMI mortality and heart failure, is unknown and could illuminate a potential pathway for adverse outcomes among post-AMI patients with 25-hydroxyvitamin D deficiency.
  
  
  METHODS
  In a cross-sectional analysis, we studied 238 AMI patients from 21 U.S. centers to test the association of nutritional vitamin D (25-hydroxyvitamin D [25(OH)D]) deficiency with NT-proBNP levels. Levels of 25(OH)D levels were categorized as normal (≥30 ng/mL), insufficient (>20 - <30 ng/mL), deficient (>10 - ≤20 ng/mL), or severely deficient (≤10 ng/mL).
  
  
  RESULTS
  Low 25(OH)D levels were found in 95.7% of AMI patients. No significant trends for higher mean baseline log NT-proBNP levels in severely deficient (6.9 ± 1.3 pg/mL), deficient (6.9 ± 1.2 pg/mL), and insufficient (6.9 ± 0.9 pg/ml) groups were observed as compared with patients having normal (6.1 ± 1.7 pg/mL) levels, P = 0.17. Findings were similar in the subset of patients who had follow-up NT-proBNP levels drawn at one month. In multivariate regression modeling, after adjusting for multiple covariates, 25(OH)D was not associated with NT-proBNP.
  
  
  CONCLUSIONS
  Potential associations between nutritional vitamin D deficiency and prognosis in the setting of AMI are unlikely to be mediated through NT-proBNP pathways. Future studies should examine other mechanisms, such as inflammation and vascular calcification, by which 25(OH)D deficiency could mediate adverse outcomes post-AMI.
authors.affiliation: Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA. jwetmore@kumc.edu.
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
authors.forename: Rajyalakshmi
authors.initials: R
authors.lastname: Gadi
authors.forename: John H
authors.initials: JH
authors.lastname: Lee
authors.forename: James H
authors.initials: JH
authors.lastname: O'Keefe
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus