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Serum Total 25 ‐ OH Vitamin D Adds Little Prognostic Value in Patients Undergoing Coronary Catheterization

View Article: PubMed Central - PubMed

ABSTRACT

Background: Vitamin D deficiency is associated with an increased risk of cardiovascular disease; however, it is unclear whether vitamin D status should be considered in clinical risk assessments of patients with cardiovascular disease.

Methods and results: This study included 2975 patients who had their first serum total 25‐hydroxy vitamin D (25‐OH vitamin D) measurement before their first coronary catheterization in Alberta, Canada. Cox regression was used to examine associations between 25‐OH vitamin D and mortality risk after adjusting for demographic and clinical risk factors. Interactions were tested using multiplicative terms, and prognostic value was assessed using measures of model discrimination, fit, calibration and net reclassification improvement. There were 401 deaths over a median of 5.8 years of follow‐up. Serum total 25‐OH vitamin D was inversely associated with mortality after adjusting for demographic and clinical risk factors, which was largely driven by excess risk in the bottom quintile (hazard ratio 1.84 for bottom versus top quintile, 95% CI 1.36–2.50, P for trend <0.001). Associations were weaker in the presence of several competing risk factors (e.g., advanced age; P for interactions <0.05). Adding 25‐OH vitamin D to a model containing demographic and clinical risk factors yielded similar discrimination, model fit, and calibration and only modest improvements in risk reclassification (net reclassification improvement 1.9% for deaths, 2.3% for survivors).

Conclusions: Pre‐catheterization, serum total 25‐OH vitamin D was inversely associated with mortality risk after adjusting for established demographic and clinical risk factors. This association was attenuated by several competing risk factors. Overall, 25‐OH vitamin D added little prognostic value over established risk factors; therefore, its measurement is not warranted in patients undergoing coronary catheterization.

No MeSH data available.


Related in: MedlinePlus

Associations between serum total 25‐OH vitamin D quintile and mortality. Median 25‐OH vitamin D is shown for each quintile. Demographic risk factors were age and sex. Clinical risk factors were body mass index, smoking status (current, prior vs never), renal disease, hypertension, hyperlipidemia, type 2 diabetes mellitus, family history of heart disease, prior myocardial infarction, congestive heart failure, whether ejection fraction was measured, ejection fraction (<20%, 20–34%, 35–50%, >50%), and Duke5 score (0–5). The number of deaths in each quintile were 115 in quintile 1, 71 in quintile 2, 64 in quintile 3, 75 in quintile 4, and 76 in quintile 5. 25‐OH vitamin D indicates 25‐hydroxyvitamin D.
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jah31770-fig-0001: Associations between serum total 25‐OH vitamin D quintile and mortality. Median 25‐OH vitamin D is shown for each quintile. Demographic risk factors were age and sex. Clinical risk factors were body mass index, smoking status (current, prior vs never), renal disease, hypertension, hyperlipidemia, type 2 diabetes mellitus, family history of heart disease, prior myocardial infarction, congestive heart failure, whether ejection fraction was measured, ejection fraction (<20%, 20–34%, 35–50%, >50%), and Duke5 score (0–5). The number of deaths in each quintile were 115 in quintile 1, 71 in quintile 2, 64 in quintile 3, 75 in quintile 4, and 76 in quintile 5. 25‐OH vitamin D indicates 25‐hydroxyvitamin D.

Mentions: Serum total 25‐OH vitamin D quintile was inversely associated with risk of mortality following coronary catheterization (hazard ratio 1.56 for bottom versus top quintile, 95% CI 1.17–2.08, P for trend <0.001), which was driven by excess risk in the first quintile (Figure). The association was strengthened (hazard ratio 2.07, 95% CI 1.54–2.78, P for trend <0.001) after adjusting for demographic risk factors (age, sex) but was weakened (hazard ratio 1.84, 95% CI 1.36–2.50, P for trend <0.001) after further adjusting for clinical risk factors. In a sensitivity analysis, adjustment for medication use, including lipid‐lowering agents, antiarrhythmia medications, blood pressure–lowering agents, anticoagulants, thrombolytic agents, antiplatelet agents, nitrates, insulin, and other blood sugar–lowering medications did not substantially change the association (data not shown). In addition, using the last 25‐OH vitamin D test result prior to catheterization weakened the association slightly (data not shown).


Serum Total 25 ‐ OH Vitamin D Adds Little Prognostic Value in Patients Undergoing Coronary Catheterization
Associations between serum total 25‐OH vitamin D quintile and mortality. Median 25‐OH vitamin D is shown for each quintile. Demographic risk factors were age and sex. Clinical risk factors were body mass index, smoking status (current, prior vs never), renal disease, hypertension, hyperlipidemia, type 2 diabetes mellitus, family history of heart disease, prior myocardial infarction, congestive heart failure, whether ejection fraction was measured, ejection fraction (<20%, 20–34%, 35–50%, >50%), and Duke5 score (0–5). The number of deaths in each quintile were 115 in quintile 1, 71 in quintile 2, 64 in quintile 3, 75 in quintile 4, and 76 in quintile 5. 25‐OH vitamin D indicates 25‐hydroxyvitamin D.
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jah31770-fig-0001: Associations between serum total 25‐OH vitamin D quintile and mortality. Median 25‐OH vitamin D is shown for each quintile. Demographic risk factors were age and sex. Clinical risk factors were body mass index, smoking status (current, prior vs never), renal disease, hypertension, hyperlipidemia, type 2 diabetes mellitus, family history of heart disease, prior myocardial infarction, congestive heart failure, whether ejection fraction was measured, ejection fraction (<20%, 20–34%, 35–50%, >50%), and Duke5 score (0–5). The number of deaths in each quintile were 115 in quintile 1, 71 in quintile 2, 64 in quintile 3, 75 in quintile 4, and 76 in quintile 5. 25‐OH vitamin D indicates 25‐hydroxyvitamin D.
Mentions: Serum total 25‐OH vitamin D quintile was inversely associated with risk of mortality following coronary catheterization (hazard ratio 1.56 for bottom versus top quintile, 95% CI 1.17–2.08, P for trend <0.001), which was driven by excess risk in the first quintile (Figure). The association was strengthened (hazard ratio 2.07, 95% CI 1.54–2.78, P for trend <0.001) after adjusting for demographic risk factors (age, sex) but was weakened (hazard ratio 1.84, 95% CI 1.36–2.50, P for trend <0.001) after further adjusting for clinical risk factors. In a sensitivity analysis, adjustment for medication use, including lipid‐lowering agents, antiarrhythmia medications, blood pressure–lowering agents, anticoagulants, thrombolytic agents, antiplatelet agents, nitrates, insulin, and other blood sugar–lowering medications did not substantially change the association (data not shown). In addition, using the last 25‐OH vitamin D test result prior to catheterization weakened the association slightly (data not shown).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Vitamin D deficiency is associated with an increased risk of cardiovascular disease; however, it is unclear whether vitamin D status should be considered in clinical risk assessments of patients with cardiovascular disease.

Methods and results: This study included 2975 patients who had their first serum total 25&#8208;hydroxy vitamin D (25&#8208;OH vitamin D) measurement before their first coronary catheterization in Alberta, Canada. Cox regression was used to examine associations between 25&#8208;OH vitamin D and mortality risk after adjusting for demographic and clinical risk factors. Interactions were tested using multiplicative terms, and prognostic value was assessed using measures of model discrimination, fit, calibration and net reclassification improvement. There were 401 deaths over a median of 5.8&nbsp;years of follow&#8208;up. Serum total 25&#8208;OH vitamin D was inversely associated with mortality after adjusting for demographic and clinical risk factors, which was largely driven by excess risk in the bottom quintile (hazard ratio 1.84 for bottom versus top quintile, 95% CI 1.36&ndash;2.50, P for trend &lt;0.001). Associations were weaker in the presence of several competing risk factors (e.g., advanced age; P for interactions &lt;0.05). Adding 25&#8208;OH vitamin D to a model containing demographic and clinical risk factors yielded similar discrimination, model fit, and calibration and only modest improvements in risk reclassification (net reclassification improvement 1.9% for deaths, 2.3% for survivors).

Conclusions: Pre&#8208;catheterization, serum total 25&#8208;OH vitamin D was inversely associated with mortality risk after adjusting for established demographic and clinical risk factors. This association was attenuated by several competing risk factors. Overall, 25&#8208;OH vitamin D added little prognostic value over established risk factors; therefore, its measurement is not warranted in patients undergoing coronary catheterization.

No MeSH data available.


Related in: MedlinePlus