title: Total 25-hydroxyvitamin D concentration as a predictor for all-cause death and cardiovascular event risk among ethnic Chinese adults: a cohort study in a Taiwan community.
abstract: BACKGROUND
  Evidence of an inverse association between serum 25-hydoroxyvitamin D [25(OH)D] and the risk of all-cause death and cardiovascular disease from prospective studies is inconsistent. We tested the relationship between 25(OH)D and the risk among adult ethnic Chinese in Taiwan.
  
  
  METHODS
  We conducted a community-based cohort study of 1816 participants (age 60.2±10.2 yrs, 45.0% women) in the Chin-Shan Community Cardiovascular Cohort Study who were free of cardiovascular diseases at baseline and provided 25(OH)D measurements.
  
  
  RESULTS
  During a median 9.6 (interquartile range, 8.8- 10.5) years' follow-up period, totally 263 cases developed cardiovascular death events and 559 participants were documented to death from any cause. As 25(OH)D concentration increased, the incidence rates of cardiovascular events and all-cause death decreased progressively. 25(OH)D was inversely associated with all-cause death: the adjusted hazard ratio was 0.49 (95% confidence interval [CI], 0.25-0.97) for the third quartile and a significant J-shape relationship was found. The performance measures by integrated discriminative improvement showed significant improvement after adding 25(OH)D information (0.14%, 95% CI, 0.03-0.31, P=0.050, for all-cause death and 0.32%, 95% CI, 0.02-0.62, P=0.018 for cardiovascular events).
  
  
  CONCLUSIONS
  These findings suggested a modest inverse association between 25(OH)D and the risk of all-cause death among diabetic participants and a good predictive factor in the community. Further studies to investigate the mechanism of vitamin D role on health effect are warranted.
authors: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Kuo-Liong
authors: KL
authors: Chien
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Hsiu-Ching
authors: HC
authors: Hsu
authors: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuang, Taiwan.
authors: Pei-Chun
authors: PC
authors: Chen
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Hung-Ju
authors: HJ
authors: Lin
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Ta-Chen
authors: TC
authors: Su
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Ming-Fong
authors: MF
authors: Chen
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Yuan-Teh
authors: YT
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D044466:Asian People; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012372:ROC Curve; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D