title: U-shaped relationship between vitamin D levels and long-term outcome in large cohort of survivors of acute myocardial infarction.
abstract: BACKGROUND
  Previous studies in the setting of patients with acute myocardial infarction (AMI) have demonstrated that hypovitaminosis D is associated with increased mortality risk during a follow-up whose median did not exceed two years.
  
  
  OBJECTIVE
  To evaluate the impact of vitamin D levels on long-term mortality in patients with AMI.
  
  
  RESULTS
  In our study 477 patients with AMI were included. During a median follow-up period of 57 (IQR 53-64) months, 93 patients (20%) died. A non-linear U-shaped relationship between 25(OH)D levels and long-term mortality was observed; patients with vitamin D<10ng/mL and >30ng/mL had higher mortality rate than those with intermediate values. After adjustment for differences in baseline features and treatment, it was confirmed that extreme values of vitamin D (<10 or >30ng/mL) are independent predictors of mortality with HR of 3.02 (95% CI 1.78-5.11). Other independent predictors of outcome were age, NYHA class at discharge, treatment with ACE inhibitors and statins. The estimated time-dependent ROC curve of the multivariable model including vitamin D showed an AUC significantly higher than the model without vitamin D: AUC 0.82 (95% CI 0.76-0.87) vs. 0.77 (95% CI 0.71-0.83), p=0.005. Addition of vitamin D to the model that included all significant factors for mortality improved the prognostic accuracy as showed by the metrics of reclassification (NRI 0.34 (95% CI 0.14-0.48), p=0.003 and IDI 0.06 (95% CI 0.01-0.12, p=0.005 p=0.03).
  
  
  CONCLUSIONS
  We report a U-shaped relationship between vitamin D levels and long-term outcome of patients surviving AMI.
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy. Electronic address: aaleksova@units.it.
authors: Aneta
authors: A
authors: Aleksova
authors: Department of Medical and Biological Sciences, University of Udine, Italy.
authors: Antonio Paolo
authors: AP
authors: Beltrami
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: Rita
authors: R
authors: Belfiore
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: Giulia
authors: G
authors: Barbati
authors: Department of Internal Medicine and Degenerative-Atherothrombotic Diseases, University Hospital of Verona, Italy.
authors: Milena
authors: M
authors: Di Nucci
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: Sara
authors: S
authors: Scapol
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: Valerio
authors: V
authors: De Paris
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: Cosimo
authors: C
authors: Carriere
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: Gianfranco
authors: G
authors: Sinagra
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D013995:Time; D013997:Time Factors; D014807:Vitamin D / Q000032:analysis / Q000097:blood; D014808:Vitamin D Deficiency / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D014807:Vitamin D
keywords: Acute myocardial infarction; Long-term mortality; Outcome; Vitamin D