title: High and low vitamin D level is associated with cardiovascular autonomic neuropathy in people with Type 1 and Type 2 diabetes.
abstract: To investigate the possible association between vitamin D deficiency and cardiovascular autonomic neuropathy in people with diabetes.
  
  
  
  A total of 113 people with Type 1 or Type 2 diabetes [mean (interquartile range) diabetes duration 22.0 (12-31) years, mean (sd) age 56.2 (13.0) years, 58% men] underwent vitamin D (D2 and D3) assessment, and were screened for cardiovascular autonomic neuropathy using three cardiovascular reflex tests [heart rate response to deep breathing (E/I ratio), to standing (30/15 ratio) and to the Valsalva manoeuvre] and assessment of 5-min resting heart rate and heart rate variability indices.
  
  
  
  We found an inverse U-shaped association between serum vitamin D level and E/I ratio, 30/15 ratio and three heart rate variability indices (P < 0.05). Vitamin D level was non-linearly associated with cardiovascular autonomic neuropathy diagnosis (P < 0.05 adjusted for age and sex). Linear regression models showed that an increase in vitamin D level from 25 to 50 nmol/l was associated with an increase of 3.9% (95% CI 0.1;7.9) in E/I ratio and 4.8% (95% CI 4.7;9.3) in 30/15 ratio. Conversely, an increase from 125 to 150 nmol/l in vitamin D level was associated with a decrease of 2.6% (95% CI -5.8;0.1) and 4.1% (95% CI -5.8;-0.5) in the respective outcome measures.
  
  
  
  High and low vitamin D levels were associated with cardiovascular autonomic neuropathy in people with diabetes. Future studies should explore this association and the efficacy of treating dysvitaminosis D to prevent cardiovascular autonomic neuropathy.
authors.affiliation: Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte.
authors.forename: C S
authors.initials: CS
authors.lastname: Hansen
authors.affiliation: Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University, Aarhus.
authors.forename: J
authors.initials: J
authors.lastname: Fleischer
authors.affiliation: Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte.
authors.forename: D
authors.initials: D
authors.lastname: Vistisen
authors.affiliation: Patient Care Centre, Steno Diabetes Centre A/S, Gentofte.
authors.forename: M
authors.initials: M
authors.lastname: Ridderstråle
authors.affiliation: Department of Cardiology, Gentofte Hospital, Gentofte.
authors.forename: J S
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte.|National Institute of Public Health, Southern Denmark University, Denmark.
authors.forename: M E
authors.initials: ME
authors.lastname: Jørgensen
mesh_terms: D015652:25-Hydroxyvitamin D 2 / Q000097:blood; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002112:Calcifediol / Q000097:blood; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D019587:Dietary Supplements / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012720:Severity of Illness Index; D014807:Vitamin D / Q000506:poisoning / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D014807:Vitamin D; D015652:25-Hydroxyvitamin D 2; D002112:Calcifediol