title: Vitamin D levels predict all-cause and cardiovascular disease mortality in subjects with the metabolic syndrome: the Ludwigshafen Risk and Cardiovascular Health (LURIC) Study.
abstract: 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.
  
  
  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.
authors.affiliation: Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK.
authors.forename: G Neil
authors.initials: GN
authors.lastname: Thomas
authors.forename: Bríain
authors.initials: B
authors.lastname: ó Hartaigh
authors.forename: Jos A
authors.initials: JA
authors.lastname: Bosch
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.forename: Adrian
authors.initials: A
authors.lastname: Loerbroks
authors.forename: Marcus E
authors.initials: ME
authors.lastname: Kleber
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Fischer
authors.forename: Tanja B
authors.initials: TB
authors.lastname: Grammer
authors.forename: Bernhard O
authors.initials: BO
authors.lastname: Böhm
authors.forename: Winfried
authors.initials: W
authors.lastname: März
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000150:complications*; D008875:Middle Aged; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D