Vitamin D deficiency is independently associated with the extent of coronary artery disease.
BACKGROUND
Vitamin D (25-OH D3) deficiency represents a rising social and economic problem in Western countries. Vitamin D has been recently reported to modulate inflammatory processes, endothelium and smooth muscle cell proliferation and even platelet function, thus potentially modulating atherothrombosis. Great interest has been addressed on its impact on cardiovascular outcome, with contrasting results. The aim of current study was to evaluate the relationship between 25-OH D3 and the extent of coronary artery disease (CAD) in a consecutive cohort of patients undergoing coronary angiography.


METHODS
Patients undergoing elective coronary angiography were included in a cross-sectional study. Fasting samples were collected for 25-OH D3 levels assessment. Significant CAD was defined as at least 1 vessel stenosis > 50%, while severe CAD as left main and/or trivessel disease, as evaluated by quantitative coronary angiography.


RESULTS
Hypovitaminosis D was observed in 70·4% of 1484 patients. Patients were divided according to vitamin D tertiles (< 9·6; 9·6-18·4; ≥ 18·4). Lower vitamin D levels were associated with age, female gender (P < 0·001), renal failure (P = 0·05), active smoking (P = 0·001), acute coronary syndrome at presentation (P < 0·001), therapy with calcium antagonists (P = 0·02) and diuretics (P < 0·001), less beta-blockers (P = 0·02) and statins (P = 0·001) use. Vitamin D was directly related to haemoglobin (P < 0·001) and inversely with platelet count (P = 0·002), total and low-density-lipoprotein cholesterol (P = 0·002 and P < 0·001) and triglycerides (P = 0·01). Vitamin D did not influence angiographic features of coronary lesions, but was associated with higher prevalence of left main or right CAD (P = 0·03). Vitamin D deficiency was significantly associated with higher prevalence of CAD (adjusted OR [95%CI] = 1·32[1·1-1·6], P = 0·004) and severe CAD (adjusted OR [95%CI] = 1·18[1-1·39], P = 0·05).


CONCLUSIONS
Hypovitaminosis D was observed in the vast majority of patients undergoing coronary angiography. Vitamin D deficiency is significantly associated with the prevalence and extent of CAD, especially for patients with values < 10 ng/mL. Therefore, future large studies are needed to evaluate whether vitamin D supplementation may prevent CAD and its progression.
Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Monica
M
Verdoia
Alon
A
Schaffer
Chiara
C
Sartori
Lucia
L
Barbieri
Ettore
E
Cassetti
Paolo
P
Marino
Gennaro
G
Galasso
Giuseppe
G
De Luca
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D002112:Calcifediol / Q000172:deficiency*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000378:metabolism; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology*; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D010976:Platelet Count; D012737:Sex Factors; D014280:Triglycerides / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000150:complications*
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D008078:Cholesterol, LDL; D004232:Diuretics; D006454:Hemoglobins; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014280:Triglycerides; D002112:Calcifediol
Coronary angiography; coronary artery disease; vitamin D