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Serum vitamin D levels correlate to coronary artery disease severity: a retrospective chart analysis
Robert Sogomonian1, Hassan Alkhawam1, JoshPaul Jolly1
1a Department of Medicine , Icahn School of Medicine at Mount Sinai , Elmhurst , NY , USA.
Insights
Vitamin D deficiency is linked to increased coronary artery disease (CAD) severity. Low vitamin D levels correlate with higher rates of obstructive CAD, suggesting its role in risk stratification.
Area of Science:
- Cardiology
- Endocrinology
- Nutritional Science
Background:
- Vitamin D deficiency is associated with increased cardiovascular events.
- The pro-atherosclerotic effects of vitamin D deficiency warrant further investigation into its impact on coronary artery disease (CAD) severity.
Purpose of the Study:
- To evaluate the association between varying serum 25-dihydroxyvitamin D (25[OH]D) levels and the severity of CAD.
- To assess the relationship between vitamin D status and coronary artery disease extent in patients presenting with chest pain.
Main Methods:
- Retrospective analysis of 1,311 patients undergoing coronary angiography.
- Serum 25(OH)D levels were categorized as deficient (<20 ng/ml), insufficient (20-29.9 ng/ml), or normal (≥30 ng/ml).
- Coronary artery disease severity was classified as normal, non-obstructive, or obstructive based on angiography findings.
Main Results:
- 23% of patients had normal 25(OH)D, 42% deficiency, and 35% insufficiency.
- Patients with normal 25(OH)D levels were more likely to have normal coronary arteries compared to those with deficiency or insufficiency (OR: 7).
- Vitamin D deficiency or insufficiency was associated with a higher likelihood of obstructive CAD (OR: 2.9) and non-obstructive CAD (OR: 1.5).
Conclusions:
- Normal serum 25(OH)D levels correlate with normal coronary arteries, while low levels are associated with CAD.
- An inverse relationship exists between coronary artery occlusion percentage and serum 25(OH)D concentrations.
- Vitamin D status may be a valuable factor in the risk stratification of patients with coronary artery disease.
Background:
The pro-atherosclerotic nature of vitamin D deficiency has been shown to increase cardiovascular events. We further emphasized and evaluated the severity of coronary artery disease (CAD) with varying levels of vitamin D in relation to age, gender, ethnicity and baseline confounders.
Methods:
A retrospective, single-center study of 9,399 patients admitted between 2005 and 2014 for chest pain who underwent coronary angiography. Patients without a vitamin D level, measured as 25-dihydroxyvitamin D (25[OH]D) were excluded from our study. 25(OH)D deficiency and insufficiency were defined by having serum concentration levels of less than 20 ng/ml and 20 to 29.9 ng/ml, respectively, while normal levels were defined as greater than or equal to 30 ng/ml. We assessed levels of 25(OH)D and extent of coronary disease with coronary angiography as obstructive CAD (left main stenosis of ≥50% or any stenosis of ≥70%), non-obstructive CAD (≥1 stenosis ≥20% but no stenosis ≥70%) and normal coronaries (no stenosis >20%).
Results:
Among 9,399 patients, 1,311 qualified, of which 308 patients (23%) had normal 25(OH)D levels, 552 patients (42%) had 25(OH)D deficiency and 451 patients (35%) had 25(OH)D insufficiency. In an analysis of the extent of coronary disease, we identified 20% of patients having normal coronaries, 55% having obstructive CAD and 25% having non-obstructive CAD. Baseline clinical risk factors and co-morbidities did not differ between the groups. Patients with normal 25(OH)D levels were found to have normal coronaries compared to patients with 25(OH)D deficiency or insufficiency (OR: 7, 95% CI: 5.2 - 9.5, p < 0.0001). Comparing patients with normal 25(OH)D levels, patients with 25(OH)D deficiency or insufficiency (<29 ng/ml), 62% were found to have obstructive CAD (n = 624, OR: 2.9, 95% CI: 2.3-3.7, p < 0.0001) and 25% had non-obstructive CAD (n = 249, OR: 1.5, 95% CI: 1.1-2, p = 0.02).
Conclusion:
Normal coronaries and CAD were shown to correlate with normal and low levels of 25(OH)D, respectively. There is an inverse relationship between the percentage of coronary artery occlusion and serum 25(OH)D concentrations. Vitamin D may provide benefits in risk stratification of patients with CAD and serve as a possible risk factor.
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