Vitamin D Deficiency as an Independent Predictor for Plaque Vulnerability and All-Cause Mortality in Patients with
Stephanie Kampf1, Olesya Harkot2, Rodrig Marculescu3
1Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, 1090 Vienna, Austria.
Insights
Vitamin D deficiency is linked to unstable carotid artery plaque and symptomatic disease. Low vitamin D levels predict major adverse cardiovascular events and mortality in patients with carotid artery stenosis.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Vascular Surgery
Background:
- The relationship between vitamin D deficiency and carotid artery stenosis (CAS) is not fully understood.
- Limited data exist on cardiovascular outcomes for CAS patients with vitamin D deficiency.
Purpose of the Study:
- To investigate the association between vitamin D deficiency, carotid plaque characteristics, and patient outcomes in high-grade CAS.
- To explore vitamin D deficiency as a potential risk factor for adverse cardiovascular events and mortality.
Main Methods:
- Included 332 patients undergoing carotid endarterectomy for symptomatic or asymptomatic CAS.
- Measured preoperative vitamin D levels and assessed plaque morphology using duplex sonography.
- Analyzed associations using univariate/multivariate regression and Cox proportional hazard models.
Main Results:
- Vitamin D deficiency was present in 25% of patients and was significantly more common in symptomatic CAS.
- Lower vitamin D levels correlated with echolucent and mixed plaques, indicative of instability.
- Vitamin D deficiency independently predicted major adverse cardiovascular events (MACE) and all-cause mortality.
Conclusions:
- Vitamin D deficiency is associated with unstable carotid plaque and symptomatic CAS.
- Vitamin D deficiency predicts adverse cardiovascular outcomes and mortality in CAS patients.
- Vitamin D may serve as a modifiable risk factor for risk stratification in carotid endarterectomy patients.
Abstract:
Objectives: The mechanisms linking vitamin D deficiency to carotid artery stenosis (CAS) remain unclear. Data on cardiovascular outcomes in CAS patients with vitamin D deficiency are limited. We investigated the association of vitamin D deficiency with carotid plaque morphology and patient outcomes in high-grade CAS. Methods: A total of 332 patients undergoing carotid endarterectomy for symptomatic (n = 113, 34%) or asymptomatic (n = 219, 66%) CAS were included. Preoperative vitamin D levels were measured, and duplex sonography was used to assess luminal narrowing. Associations of vitamin D with clinical presentation were analyzed using univariate and multivariate linear regression. For vitamin D deficiency and the prediction of major adverse cardiovascular events (MACE) and all-cause mortality, the Cox proportional hazard regression model was used. Results: The median age was 69 years (interquartile range (IQR) 64-74), and 94 (29.3%) patients were female. Vitamin D deficiency was present in 84 (25%) patients. Symptomatic patients had significantly lower vitamin D levels (41.2 nmol/L, IQR 25.1-63.5) than asymptomatic patients (51.6 nmol/L, IQR 30.5-74.3, p = 0.011). Patients with echolucent (44.9 nmol/L, IQR 27.4-73.7) or mixed plaques (39.2 nmol/L, IQR 22.9-63.5) had lower vitamin D levels than those with echogenic plaques (52.3 nmol/L, IQR 34.1-75.7). Vitamin D deficiency predicted MACE and all-cause mortality with an adjusted HR of 1.6, 95% CI of 1.1-2.6, and p = 0.030 and an HR of 2.2, 95% CI of 1.3-3.6, and p = 0.002, respectively, in a multivariable Cox proportional hazard regression model. Conclusions: A deficiency in vitamin D was correlated with unstable plaque characteristics and symptomatic CAS. Furthermore, vitamin D deficiency was associated with long-term adverse cardiovascular outcomes and mortality, suggesting its potential as a modifiable risk factor for improved risk stratification in patients undergoing carotid endarterectomy.
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