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The Effect of Vitamin D on Coronary Atherosclerosis: A Propensity Score Matched Case-Control Coronary CTA Study
Gudrun Feuchtner1, Simon Suppersberger1, Christian Langer1
1Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Insights
Vitamin D supplementation may reduce high-risk coronary plaque and non-calcified plaque burden. This suggests a potential benefit in managing coronary atherosclerosis, independent of cardiovascular risk factors.
Area of Science:
- Cardiology
- Endocrinology
- Radiology
Background:
- Controversial data links vitamin D supplementation to cardiovascular events.
- The direct impact of vitamin D on coronary atherosclerosis remains unclear.
- This study investigates vitamin D's effect on coronary atherosclerosis using computed tomography angiography (CTA).
Purpose of the Study:
- To assess the influence of vitamin D supplementation on coronary atherosclerosis.
- To quantify plaque characteristics using CTA in patients receiving vitamin D.
- To compare coronary atherosclerosis profiles between vitamin D supplemented patients and controls.
Main Methods:
- Retrospective case-control study of 176 patients undergoing coronary CTA.
- 88 patients on vitamin D were matched with 88 controls based on cardiovascular risk factors.
- CTA quantified coronary stenosis (CAD-RADS), plaque burden, high-risk-plaque (HRP) features, and plaque density (HU).
Main Results:
- No significant difference in overall atherosclerosis prevalence between groups.
- Vitamin D group showed lower mixed plaque burden (p=0.002) and markedly lower HRP prevalence (p<0.001).
- Higher CT plaque density (HU) observed in the vitamin D group (p<0.001), indicating more calcified plaque.
Conclusions:
- Vitamin D supplementation is associated with reduced high-risk plaque and non-calcified plaque burden.
- Supplementation correlated with increased calcified plaque, suggesting a more stable plaque phenotype.
- These findings suggest a potential protective role of vitamin D in coronary atherosclerosis, independent of traditional risk factors.
Background:
Vitamin D supplementation may be associated with lower cardiovascular (CV) events, but the data are controversial. It remains speculative whether vitamin D supplementation has a direct effect on coronary atherosclerosis. We therefore set out to assess the influence of vitamin D supplementation on the coronary atherosclerosis profile quantified by coronary computed tomography angiography (CTA) in a retrospective case-control cohort study.
Methods:
176 patients (age: 62.4 ± 10.4) referred to coronary CTA for clinical indications were included. A total of 88 patients receiving vitamin D supplementation (mean duration 65.3 ± 81 months) were 1:1 propensity score matched with 88 controls for age, gender, smoking, arterial hypertension, positive family history, dyslipidemia, and diabetes. Coronary stenosis severity (CAD-RADSTM), mixed plaque burden (weighted for non-calcified), high-risk-plaque (HRP) features, and plaque density (HU) were quantified by CTA. Serum 25-hydroxyvitamin D (OH)-levels were measured in 138 patients and categorized into four groups (0: <20 ng/mL; 1: 20-40 ng/mL; 2: 40-60 ng/mL; and 3: >60 ng/mL) and compared with CTA.
Results:
The prevalence of atherosclerosis by CTA was similar in both groups (75.6% versus 74.3%, p = 0.999), >50% coronary stenosis was slightly higher in controls (p = 0.046), but stenosis severity score (CAD-RADS) was not different (p = 0.106). Mixed plaque burden (weighted for non-calcified) was lower in patients receiving vitamin D supplementation (p = 0.002) and high-risk-plaque prevalence was markedly lower (3.8% versus 32%, p < 0.001). CT plaque density (HU) was higher (p < 0.001) in the vitamin D group. Patients with serum vitamin D (OH) levels >60 ng/mL had higher plaque density (p = 0.04), indicating more calcified and less vulnerable plaque.
Conclusions:
In this retrospective case-control cohort study, vitamin D supplementation was associated with less high-risk plaque, less non-calcified plaque burden, and a higher calcified plaque independent of CV risk factors.
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