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Vitamin D status, vitamin D receptor polymorphisms, and risk of cardiometabolic multimorbidity
Jianhua Ma1,2, Pingan Li1,2, Jinqi Wang1,2
1School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.
Insights
Adequate vitamin D levels and specific vitamin D receptor (VDR) gene variants can reduce cardiometabolic disease (CMD) risk and slow progression to cardiometabolic multimorbidity (CMM) or death. VDR polymorphisms may personalize prevention strategies for CMM.
Area of Science:
- Endocrinology
- Genetics
- Public Health
Background:
- Cardiometabolic multimorbidity (CMM) prevalence is rising.
- Vitamin D and VDR polymorphisms are linked to individual cardiometabolic diseases (CMD).
- The role of vitamin D and VDR in CMM progression and mortality is not well understood.
Purpose of the Study:
- To investigate associations between vitamin D, VDR polymorphisms, and CMM progression dynamics.
- To explore how VDR polymorphisms modify the effects of vitamin D on CMM progression.
Main Methods:
- Utilized UK Biobank data from 396,192 participants.
- Defined CMM as co-occurrence of at least two CMDs (T2D, CHD, stroke).
- Employed a multi-state model to analyze serum 25(OH)D and VDR polymorphism associations with CMM progression.
Main Results:
- Higher serum 25(OH)D (≥75 nmol/L) correlated with reduced risk for baseline to first CMD, first CMD to CMM, and baseline to death.
- L-shaped associations observed, with a potential threshold around 45 nmol/L for vitamin D.
- Specific VDR polymorphisms (rs1544410 T alleles detrimental; rs11568820 T alleles protective) and their interaction with vitamin D levels were identified.
Conclusions:
- Maintaining adequate vitamin D levels is crucial for reducing CMD risk and delaying CMM or death.
- VDR polymorphisms can modify vitamin D's effects, enabling risk stratification.
- Personalized prevention strategies for CMM can be developed based on VDR genotype and vitamin D status.
Background:
The prevalence of cardiometabolic multimorbidity (CMM) has increased substantially in recent years. Previous studies have established the associations between vitamin D, vitamin D receptor (VDR) polymorphisms, and the risk of individual cardiometabolic disease (CMD). However, the role of these factors in the progression of CMD to CMM or mortality remains unclear. This study aimed to investigate the associations between vitamin D, VDR polymorphisms, and the dynamic progression of CMM, as well as to explore the potential modification effect of VDR polymorphisms.
Methods:
Data for this cohort study were extracted from the UK Biobank. CMM was defined as the coexistence of at least two CMDs, including type 2 diabetes (T2D), coronary heart disease (CHD), and stroke. A multi-state model was used to analyze associations between serum 25(OH)D, VDR polymorphisms and the dynamic progression of CMM.
Results:
The sample included 396,192 participants. Over a median follow-up of 13.8 years, 55,772 individuals experienced at least one CMD and 28,624 died. Compared to participants with 25(OH)D < 25 nmol/L, those with 25(OH)D ≥ 75 nmol/L had HRs of 0.70 (95% CI, 0.67, 0.72) for baseline to first CMD (FCMD), 0.74 (95% CI, 0.67, 0.82) for FCMD to CMM, 0.66 (95% CI, 0.62, 0.70) for baseline to death, 0.84 (95% CI, 0.77, 0.92) for FCMD to death, and 0.85 (95% CI, 0.70, 1.03) for CMM to death. L-shaped relationships of these associations were noted, with a threshold around 45 nmol/L. The rs1544410 (BsmI) T alleles may have a detrimental effect, while the rs11568820 (Cdx2) T alleles may exert a protective effect in the early stages of CMM progression. Additionally, VDR polymorphisms significantly modified the association between serum 25(OH)D and certain stages of CMM progression.
Conclusions:
Maintaining adequate vitamin D levels, as a readily implementable intervention strategy, not only reduces the risk of initial CMD but also delays the progression to CMM or death. Risk stratification based on VDR polymorphisms provides further insights for developing personalized prevention strategies.
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