title: Vitamin D and risk of death from vascular and non-vascular causes in the Whitehall study and meta-analyses of 12,000 deaths.
abstract: OBJECTIVE
  To examine the independent relevance of plasma concentrations of 25-hydroxyvitamin D [25(OH)D] for vascular and non-vascular mortality.
  
  
  RESULTS
  We examined associations of plasma concentrations of 25(OH)D and cause-specific mortality in a prospective study of older men living in the UK and included findings in meta-analyses of similar studies identified by a systematic search reporting on vascular and all-cause mortality. In a 13-year follow-up of 5409 men (mean baseline age 77 years), 1358 died from vascular and 1857 from non-vascular causes. Median season-adjusted baseline 25(OH)D concentration was 56 (interquartile range: 45-67) nmol/L. After adjustment for age and seasonality, higher concentrations of 25(OH)D were inversely and approximately linearly (log-log scale) associated with vascular and non-vascular mortality throughout the range 40-90 nmol/L. After additional adjustment for prior disease and cardiovascular risk factors, a doubling in 25(OH)D concentration was associated with 20% [95% confidence interval (CI): 9-30%] lower vascular and 23% (95% CI: 14-31%) lower non-vascular mortality. In meta-analyses of prospective studies, individuals in the top vs. bottom quarter of 25(OH)D concentrations had 21% (95% CI: 13-28%) lower vascular and 28% (95% CI: 24-32%) lower all-cause mortality.
  
  
  CONCLUSIONS
  Despite strong inverse and apparently independent associations of 25(OH)D with vascular and non-vascular mortality, causality remains uncertain. Large-scale randomized trials, using high doses of vitamin D, are required to assess the clinical relevance of these associations.
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tomson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Emberson
authors.forename: Michael
authors.initials: M
authors.lastname: Hill
authors.forename: Andrew
authors.initials: A
authors.lastname: Gordon
authors.forename: Jane
authors.initials: J
authors.lastname: Armitage
authors.forename: Martin
authors.initials: M
authors.lastname: Shipley
authors.forename: Rory
authors.initials: R
authors.lastname: Collins
authors.forename: Robert
authors.initials: R
authors.lastname: Clarke
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000401:mortality*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D