Plasma 25-Hydroxyvitamin D and Mortality in Patients With Suspected Stable Angina Pectoris
Eirik Degerud1, Ottar Nygård2,3, Stefan de Vogel4
1Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Insights
Vitamin D levels impact cardiovascular health. Low or very high 25-hydroxyvitamin D (25OHD) is linked to increased mortality risk, with an inverse association for cardiovascular death.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Nutritional Science
Background:
- Vitamin D status is implicated in cardiovascular disease (CVD) development and patient survival.
- Circulating 25-hydroxyvitamin D (25OHD) is a key biomarker for assessing vitamin D status.
- Understanding the relationship between 25OHD levels and mortality risk is crucial for public health.
Purpose of the Study:
- To investigate the association between plasma 25-hydroxyvitamin D (25OHD) concentrations and all-cause and cardiovascular mortality.
- To determine the specific mortality risks associated with different ranges of 25OHD levels in patients with suspected stable angina.
Main Methods:
- Plasma 25OHD levels were measured in 4114 white patients with suspected stable angina pectoris.
- Seasonal variation was accounted for, and multivariable Cox models were used to estimate hazard ratios (HRs) for mortality.
- Adjustments were made for factors including age, sex, smoking, BMI, kidney function, and blood pressure.
Main Results:
- A total of 895 deaths (21.8%) occurred during follow-up, with 407 (9.9%) from CVD.
- Compared to the lowest quartile, higher 25OHD quartiles showed reduced all-cause and cardiovascular mortality risk.
- Increased mortality risk was observed at 25OHD levels below approximately 42.5 nmol/L and above 100 nmol/L.
Conclusions:
- Plasma 25OHD concentrations demonstrated an inverse association with cardiovascular mortality.
- A nonlinear, U-shaped association was found between 25OHD levels and all-cause mortality.
- Both very low and very high vitamin D levels may be detrimental to patient survival.
Context And Objective:
Vitamin D status may affect cardiovascular disease (CVD) development and survival. We studied the relationship between concentrations of the circulating biomarker 25-hydroxyvitamin D (25OHD) and all-cause and cardiovascular mortality risk.
Design, Setting, Participants, And Main Outcome Measures:
25OHD, the sum of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2, was analyzed in plasma samples from 4114 white patients suspected of having stable angina pectoris and was adjusted for seasonal variation. Hazard ratios (HRs) for all-cause and cardiovascular mortality were estimated by using multivariable Cox models with 25OHD as the main exposure variable, with adjustment for study site, age, sex, smoking, body mass index, estimated glomerular filtration rate, and systolic blood pressure.
Results:
A total of 895 (21.8%) deaths, including 407 (9.9%) from CVD causes, occurred during a mean ± standard deviation follow-up of 11.9 ± 3.0 years. Compared with the first 25OHD quartile, HRs in the second, third, and fourth quartiles were 0.64 [95% confidence interval (CI), 0.54 to 0.77], 0.56 (95% CI, 0.46 to 0.67), and 0.56 (95% CI, 0.46 to 0.67) for all-cause mortality and 0.70 (95% CI, 0.53 to 0.91), 0.60 (95% CI, 0.45 to 0.79), and 0.57 (95% CI, 0.43 to 0.75) for cardiovascular mortality, respectively. Threshold analysis demonstrated increased all-cause and CVD mortality in patients with 25OHD concentrations below ∼42.5 nmol/L. Moreover, analysis suggested increased all-cause mortality at concentrations >100 nmol/L.
Conclusion:
Plasma 25OHD concentrations were inversely associated with cardiovascular mortality and nonlinearly (U-shaped) associated with all-cause mortality.
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