title: Vitamin D status and the risk of major adverse cardiac and cerebrovascular events in cardiac surgery.
abstract: OBJECTIVE
  A significant proportion of cardiac surgical patients develop critical post-operative complications. We aimed to investigate the association of pre-operative 25-hydroxyvitamin D (25(OH)D) levels with major cardiac and cerebrovascular events (MACCE) in cardiac surgical patients.
  
  
  RESULTS
  From January 2010 to August 2011, we consecutively measured circulating 25(OH)D in 4418 operated patients. Of the study cohort, 38.0% had deficient 25(OH)D values (<30 nmol/L) and additional 32.3% had insufficient values (30-49.9 nmol/L), whereas only 3.1% had values >100 nmol/L. The incidence of MACCE was 11.5%. In multivariable-adjusted logistic regression models, the odds ratio of MACCE at deficient, inadequate, and high 25(OH)D levels was 2.23 [95% confidence interval (CI): 1.31-3.79], 1.73 (95% CI: 1.01-2.96) and 2.34 (95% CI: 1.12-4.89), respectively, compared with 25(OH)D levels of 75-100 nmol/L. A U-shaped association with circulating 25(OH)D was also present for duration of mechanical ventilatory support and intensive care unit stay. Multivariable-adjusted 6- and 12-month mortality were higher in patients with deficient 25(OH)D levels compared with patients with 25(OH)D levels of 75-100 nmol/L.
  
  
  CONCLUSIONS
  Deficient 25(OH)D levels are prevalent in cardiac surgical patients in Central Europe and are independently associated with the risk of MACCE. Further research should clarify the potential of vitamin D supplements in reducing cardiovascular risk in vitamin D-deficient patients and also the mechanisms leading to adverse effects on the cardiovascular system in the small group of patients with 25(OH)D levels >100 nmol/L.
authors: Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstrasse 11, Bad Oeynhausen, Germany. azittermann@hdz-nrw.de
authors: Armin
authors: A
authors: Zittermann
authors: Joachim
authors: J
authors: Kuhn
authors: Jens
authors: J
authors: Dreier
authors: Cornelius
authors: C
authors: Knabbe
authors: Jan F
authors: JF
authors: Gummert
authors: Jochen
authors: J
authors: Börgermann
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D002561:Cerebrovascular Disorders / Q000097:blood / Q000209:etiology*; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000209:etiology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Cardiac surgery; Kidney function; Major adverse cardiac and cerebrovascular event; Mortality; Survival; Vitamin D