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The relationship between vitamin D and risk of atrial fibrillation: a dose-response analysis of observational studies
Xiao Liu1, Wei Wang1, Zhaochong Tan1
1Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
Insights
Vitamin D deficiency increases the risk of atrial fibrillation (AF). Higher vitamin D levels are linked to reduced AF risk, especially in older adults and after coronary artery bypass graft (CABG) surgery.
Area of Science:
- Cardiology
- Endocrinology
- Nutritional Science
Background:
- The association between serum vitamin D levels and atrial fibrillation (AF), including postoperative AF (POAF), remains debated.
- A clear dose-response relationship between vitamin D and AF risk is not well-established.
Purpose of the Study:
- To investigate the dose-response relationship between serum vitamin D levels and the risk of AF and POAF.
- To analyze age-specific associations between vitamin D and AF risk.
Main Methods:
- A comprehensive literature search was conducted across Cochrane Library, PubMed, and Embase.
- A meta-analysis using a one-stage approach with restricted cubic splines was employed to assess dose-specific relationships.
- Relative risk (RR) was used to quantify the effects of vitamin D on AF and POAF.
Main Results:
- Vitamin D deficiency (<20 ng/ml) was associated with a higher risk of AF (RR: 1.23).
- Each 10 ng/ml increase in vitamin D was associated with an 12% reduced risk of AF (RR: 0.88), with no evidence of non-linearity.
- Higher vitamin D levels significantly reduced AF risk in individuals over 65 (RR: 0.68) and POAF risk post-CABG (RR: 0.44).
Conclusions:
- Serum vitamin D deficiency is linked to increased AF risk in the general population and POAF risk in post-CABG patients.
- Further research is warranted to explore age-related differences and the potential of vitamin D supplementation for AF prevention.
Background:
The relationship between serum vitamin D and atrial fibrillation (AF) or postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass graft (CABG) is still debated. It is also unclear whether there is a dose-response relationship between circulating vitamin D and the risk of AF or POAF.
Methods:
The Cochrane Library, PubMed, and Embase databases were searched for relevant studies. We used a "one-stage approach" with a restricted cubic spline model to summarize the dose-specific relationships between serum vitamin D and AF. Relative risk (RR) was used to measure the effects in this meta-analysis.
Results:
In total, 13 studies were included with a total of 6519 cases of AF among 74,885 participants. Vitamin D deficiency (< 20 ng/ml) was associated with increased risks of AF (RR: 1.23, 95% CI: 1.05-1.43). In the dose-response analysis, the summary RR for a 10 ng/ml increased in vitamin D was 0.88 (95% CI: 0.78-0.98) and there was no evidence of a non-linear association, Pnon-linearity = 0.86. In the age subgroup, high vitamin D (per 10 ng/ml increase) reduced the risk of AF in the older group (> 65 years) (RR = 0.68, 95% CI = 0.52-0.89) but not among young individuals (< 65 years) (RR = 0.87, 95% CI = 0.72-1.06). In addition, a strong association was found between a 10 ng/ml increased in vitamin D and POAF incident in the patient after CABG (RR: 0.44, 95% CI: 0.24-0.82).
Conclusion:
Our dose-response meta-analysis suggested serum vitamin D deficiency was associated with an increased risk of AF in the general population and POAF in patients after CABG. Further studies are needed to explore the age difference in the association between serum vitamin D level and the risk of AF and whether vitamin D supplements will prevent AF.
Trial Registration:
This study has been registered with PROSPERO (International prospective register of systematic reviews)-registration number-CRD42019119258.
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