title: A prospective observational study of all-cause mortality in relation to serum 25-OH vitamin D3 and parathyroid hormone levels in patients with type 2 diabetes.
abstract: BACKGROUND
  Low levels of vitamin D have been related to increased mortality and morbidity in several non-diabetic studies. We aimed to prospectively study relationships between serum 25-OH vitamin D3 (vitamin D) and of serum parathyroid hormone (PTH) to total mortality in type 2 diabetes. We also aimed to compare the levels of these potential risk-factors in patients with and without diabetes.
  
  
  METHODS
  The main study design was prospective and observational. We used baseline data from 472 men and 245 women who participated in the "Cardiovascular Risk factors in Patients with Diabetes-a Prospective study in Primary care" study. Patients were 55-66 years old at recruitment, and an age-matched non-diabetic sample of 129 individuals constituted controls for the baseline data. Carotid-femoral pulse-wave velocity (PWV) was measured with applanation-tonometry and carotid intima-media thickness (IMT) with ultrasound. Patients with diabetes were followed for all-cause mortality using the national Swedish Cause of Death Registry.
  
  
  RESULTS
  Levels of vitamin D were lower in patients with diabetes than in controls, also after correction for age and obesity, while PTH levels did not differ. Nine women and 24 men died during 6 years of median follow up of the final cohort (n = 698). Vitamin D levels were negatively related to all-cause mortality in men independently of age, PTH, HbA1c, waist circumference, 24-h systolic ambulatory-blood pressure (ABP) and serum-apoB (p = 0.049). This finding was also statistically significant when PWV and IMT were added to the analyses (p = 0.028) and was not affected statistically when medications were also included in the regression-analysis (p = 0.01). In the women with type 2 diabetes, levels of PTH were positively related with all-cause mortality in the corresponding calculations (p = 0.016 without PWV and IMT, p = 0.006 with PWV and IMT, p = 0.045 when also adding medications to the analysis), while levels of vitamin D was without statistical significance (p >0.9).
  
  
  CONCLUSIONS
  Serum vitamin D in men and serum PTH in women give prognostic information in terms of total-mortality that are independent of regular risk factors in addition to levels of ABP, IMT and PWV.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01049737.
authors.affiliation: Department of Medical and Health Sciences, Linköping University, SE 581 83 Linköping, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Jennersjö
authors.affiliation: Department of Medical and Health Sciences, Linköping University, SE 581 83 Linköping, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Guldbrand
authors.affiliation: Department of Medical and Health Sciences, Linköping University, SE 581 83 Linköping, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Björne
authors.affiliation: Department of Medical and Health Sciences, Linköping University, SE 581 83 Linköping, Sweden.
authors.forename: Toste
authors.initials: T
authors.lastname: Länne
authors.affiliation: Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Fredrikson
authors.affiliation: Department of Medical and Health Sciences, Linköping University, SE 581 83 Linköping, Sweden.
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Lindström
authors.affiliation: Department of Internal Medicine and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Wijkman
authors.affiliation: Department of Medical and Health Sciences, Linköping University, SE 581 83 Linköping, Sweden.
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Östgren
authors.affiliation: Department of Medical and Health Sciences, Linköping University, SE 581 83 Linköping, Sweden.
authors.forename: Fredrik H
authors.initials: FH
authors.lastname: Nystrom
keywords: Arteriosclerosis; Calcium; Mortality; Parathyroid hormone; Type 2 diabetes; Vitamin D