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Updated: Jun 22, 2025
In Vitro Model of Coronary Angiogenesis
Published on: March 10, 2020
Vitamin D Deficiency, Inflammation, and Diminished Endogenous Regenerative Capacity in Coronary Heart Disease
Shivang R Desai1, Yi-An Ko1, Chang Liu2
1Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Vitamin D deficiency (VDD) in coronary heart disease (CHD) patients is linked to increased cardiovascular mortality, especially when combined with inflammation or low progenitor cell counts. Further research is needed to determine if targeted supplementation benefits these high-risk individuals.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Immunology
Background:
- Vitamin D deficiency (VDD) is prevalent in patients with coronary heart disease (CHD).
- VDD is associated with adverse outcomes in CHD, potentially due to inflammation and impaired progenitor cell function.
- Current supplementation strategies do not consistently improve prognosis in CHD patients with VDD.
Purpose of the Study:
- To investigate the relationship between VDD, inflammation (hsCRP), and circulating progenitor cell (CPC) counts in patients with CHD.
- To determine if VDD, inflammation, and reduced regenerative capacity mediate the increased risk of adverse cardiovascular outcomes.
- To validate findings in an independent patient cohort.
Main Methods:
- Analysis of 25-hydroxyvitamin D, hsCRP, and CD34+ CPC counts in 5,452 individuals with CHD.
- Validation of findings in an independent cohort.
- Use of Cox and Fine-Gray models to assess associations with all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
Main Results:
- VDD was present in 43.6% of individuals and associated with higher adjusted cardiovascular mortality (HR: 1.57).
- Significant interactions were observed between VDD and hsCRP/CPC counts in predicting cardiovascular mortality.
- The highest risk was seen in individuals with both VDD and elevated hsCRP (HR: 2.82) or VDD and low CPC counts (HR: 2.25).
Conclusions:
- VDD is a significant predictor of adverse outcomes in patients with CHD.
- Combined VDD with inflammation or diminished regenerative capacity substantially increases cardiovascular mortality risk.
- The efficacy of targeted supplementation in these high-risk populations requires further investigation.
Background:
Vitamin D deficiency (VDD) is associated with coronary heart disease (CHD) and poor outcomes, but supplementation does not improve prognosis. VDD has been implicated in and may promote greater risk through inflammation and impaired progenitor cell function.
Objectives:
The authors examined VDD, high-sensitivity C-reactive protein (hsCRP), circulating progenitor cell (CPC) counts, and outcomes in patients with CHD. They hypothesized that the higher risk with VDD is mediated by inflammation and impaired regenerative capacity.
Methods:
A total of 5,452 individuals with CHD in the Emory Cardiovascular Biobank had measurement of 25-hydroxyvitamin D, subsets of whom had hsCRP measurements and CPCs estimated as CD34-expressing mononuclear cell counts. Findings were validated in an independent cohort. 25-hydroxyvitamin D <20 ng/mL was considered VDD. Cox and Fine-Gray models determined associations between marker levels and: 1) all-cause mortality; 2) cardiovascular mortality; and 3) major adverse cardiovascular events, a composite of adverse CHD outcomes.
Results:
VDD (43.6% of individuals) was associated with higher adjusted cardiovascular mortality (HR: 1.57, 95% CI: 1.09-2.28). There were significant interactions between VDD and hsCRP and CPC counts in predicting cardiovascular mortality. Individuals with both VDD and elevated hsCRP had the greatest risk (HR: 2.82, 95% CI: 2.16-3.67). Only individuals with both VDD and low CPC counts were at high risk (HR: 2.25, 95% CI: 1.46-3.46). These findings were reproduced in the validation cohort.
Conclusions:
VDD predicts adverse outcomes in CHD. Those with VDD, inflammation and/or diminished regenerative capacity are at a significantly greater risk of cardiovascular mortality. Whether targeted supplementation in these high-risk groups improves risk warrants further study.
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