title: Major electrocardiographic abnormalities and 25-hydroxy vitamin D deficiency: insights from National Health and Nutrition Examination Survey-III.
abstract: BACKGROUND
  We explored the relationship between major electrocardiogram (ECG) abnormalities (mECG) and 25-hydroxy (25-OH) vitamin D deficiency (VDD) and the effect of mECG abnormalities on all-cause and cardiovascular mortality in a healthy cohort with 25-OH vitamin D insufficiency and deficiency.
  
  
  OBJECTIVE
  Lower levels of serum 25-OH vitamin D are associated with increased prevalence of mECG on resting ECG.
  
  
  METHODS
  We identified 5108 individuals from the National Health and Nutrition Examination Survey-III. mECG abnormalities included: major Q-QS wave abnormalities, ST depression/elevation, negative T waves, Wolff-Parkinson-White pattern, and ventricular conduction defect. Our cohort was divided into 3 groups based on 25-OH vitamin D levels: Group 1 (referent): > 40 ng/mL; group 2 (insufficient): ≥ 20.01 to ≤ 40 ng/mL; and group 3 (deficient): ≤ 20 ng/mL. Logistic regression and Cox proportional hazards regression models were built.
  
  
  RESULTS
  The prevalence of major ECG abnormalities across 25-OH vitamin D sufficiency, insufficiency, and deficiency was .9%, 11%, and 13 %, respectively (P = 0.01). VDD was an independent predictor of mECG abnormalities after adjusting for traditional risk factors (continuous variable odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.97-0.99, P = 0.007; categorical variable group 3 vs group 1 OR: 2.36, 95% CI: 1.1-5.12, P = 0.03). Baseline major ECG abnormalities were predictive of long-term all-cause (hazard ratio [HR]:1.52, 95% CI: 1.23-1.89), composite cardiovascular (HR: 1.7, 95% CI: 1.34-2.15), cardiovascular (HR: 1.64, 95% CI: 1.27-2.12), and ischemic heart disease mortality (HR: 1.98, 95% CI: 1.46-2.69) in individuals with 25-OH vitamin D levels ≤ 40 ng/mL.
  
  
  CONCLUSIONS
  VDD is associated with increased prevalence of major ECG abnormalities. Well-structured trials are needed to assess progression/resolution of mECG abnormalities with vitamin D supplementation in deficient individuals.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
authors.forename: Tushar A
authors.initials: TA
authors.lastname: Tuliani
authors.forename: Maithili
authors.initials: M
authors.lastname: Shenoy
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.forename: Ankit
authors.initials: A
authors.lastname: Rathod
authors.forename: Sadip
authors.initials: S
authors.lastname: Pant
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.forename: Diane
authors.initials: D
authors.lastname: Levine
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000401:mortality; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000453:epidemiology*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D