title: Association between serum 25(OH)D3and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study.
abstract: We aimed to explore the association between vitamin D and cardiovascular morbidity and mortality in people with Type 2 diabetes recruited from a community-based study because there is limited and inconsistent research of this group.
  
  
  
  A prospective community-based cohort study among people aged 55-66 years with Type 2 diabetes as part of The Cardiovascular Risk in Type 2 Diabetes - A Prospective Study in Primary Care (CARDIPP). We analysed serum 25-hydroxyvitamin D3[25(OH)D3] at baseline. Cox regression analyses were used to calculate hazard ratios (HR) for the first myocardial infarction, stroke or cardiovascular mortality according to 25(OH)D3.
  
  
  
  We examined 698 people with a mean follow-up of 7.3 years. Serum 25(OH)D3was inversely associated with the risk of cardiovascular morbidity and mortality: HR 0.98 [95% confidence interval (CI) 0.96 to 0.99, P = 0.001]. Compared with the fourth quartile (Q4) [25(OH)D3> 61.8 nmol/l], HR (with 95% CI) was 3.46 (1.60 to 7.47) in Q1 [25(OH)D3< 35.5 nmol/l] (P = 0.002); 2.26 (1.01 to 5.06) in Q2 [25(OH)D335.5-47.5 nmol/l] (P = 0.047); and 1.62 (0.70 to 3.76) in Q3 [25(OH)D347.5-61.8 nmol/l] (P = 0.26) when adjusting for age, sex and season. The results remained significant after adjusting also for cardiovascular risk factors, physiological variables including parathyroid hormone and previous cardiovascular disease (P = 0.027).
  
  
  
  Low 25(OH)D3is associated with an increased risk of cardiovascular morbidity and mortality in people with Type 2 diabetes independent of parathyroid hormone. Vitamin D could be considered as a prognostic factor. Future studies are needed to explore whether vitamin D deficiency is a modifiable risk factor in Type 2 diabetes.
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: M
authors.identifier: 0000-0003-2797-764X
authors.initials: M
authors.lastname: Samefors
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Scragg
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Länne
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: F H
authors.initials: FH
authors.lastname: Nyström
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: C J
authors.initials: CJ
authors.lastname: Östgren
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002112:Calcifediol / Q000097:blood*; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D058065:Diabetic Cardiomyopathies / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D002112:Calcifediol