Serum 25(OH)D is a 2-year predictor of all-cause mortality, cardiac death and sudden cardiac death in chest pain patients from Northern Argentina

Patrycja A Naesgaard, Ricardo A León De La Fuente, Stein Tore Nilsen, Leik Woie, Torbjoern Aarsland, Cato Brede, Harry Staines, Dennis W T Nilsen, Patrycja A Naesgaard, Ricardo A León De La Fuente, Stein Tore Nilsen, Leik Woie, Torbjoern Aarsland, Cato Brede, Harry Staines, Dennis W T Nilsen

Abstract

Background: Several studies have shown an association between vitamin D deficiency and cardiovascular risk. Vitamin D status is assessed by determination of 25-hydroxyvitamin D [25(OH)D] in serum.

Methods: We assessed the prognostic utility of 25(OH)D in 982 chest-pain patients with suspected acute coronary syndrome (ACS) from Salta, Northern Argentina. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death were analyzed in quartiles of 25(OH)D, applying univariate and multivariate analysis.

Results: There were statistically significant changes in seasonal 25(OH)D levels. At follow-up, 119 patients had died. The mean 25(OH)D levels were significantly lower among patients dying than in long-term survivors, both in the total population and in patients with a troponin T (TnT) release (n = 388). When comparing 25(OH)D in the highest quartile to the lowest quartile in a multivariable Cox regression model for all-cause mortality, the hazard ratio (HR) for cardiac death and sudden cardiac death in the total population was 0.37 (95% CI, 0.19-0.73), p = 0.004, 0.23 (95% CI, 0.08-0.67), p = 0.007, and 0.32 (95% CI, 0.11-0.94), p = 0.038, respectively. In patients with TnT release, the respective HR was 0.24 (95% CI, 0.10-0.54), p = 0.001, 0.18 (95% CI, 0.05-0.60), p = 0.006 and 0.25 (95% CI, 0.07-0.89), p = 0.033. 25(OH)D had no prognostic value in patients with no TnT release.

Conclusion: Vitamin D was shown to be a useful biomarker for prediction of mortality when obtained at admission in chest pain patients with suspected ACS.

Trial registration: ClinicalTrials.gov NCT01377402.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Mean 25(OH)D levels by month.
Figure 1. Mean 25(OH)D levels by month.
Figure 2. Kaplan-Meier plots for total mortality…
Figure 2. Kaplan-Meier plots for total mortality of 25(OH)D quartiles in the total patient population.
Figure 3. Receiver operated characteristics curve for…
Figure 3. Receiver operated characteristics curve for 25(OH)D related to all-cause mortality in the total patient population.
Figure 4. Kaplan-Meier plots for total mortality…
Figure 4. Kaplan-Meier plots for total mortality of 25(OH)D quartiles in patients with TnT release.
Figure 5. Receiver operated characteristics curve for…
Figure 5. Receiver operated characteristics curve for 25(OH)D related to all-cause mortality in patients with TnT release.

References

    1. Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, et al. (2009) on behalf of the IOF Committee of Scientific Advisors (CSA) Nutrition Working Group (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20: 1807–1820.
    1. Judd SE, Tangpricha V (2009) Vitamin D Deficiency and Risk for Cardiovascular Disease. Am J Med Sci 338: 40–44.
    1. Holick MF (2007) Vitamin D Deficiency. N Engl J Med 357: 266–281.
    1. Pilz S, Tomaschitz A, März W, Drechsler C, Ritz E, et al. (2011) Vitamin D, cardiovascular disease and mortality. Clin Endocrinol 75: 575–584.
    1. Kilkkinen A, Knekt P, Aro A, Rissanen H, Marniemi J, et al. (2009) Vitamin D Status and the Risk of Cardiovascular Disease Death. Am J Epidemiol 170: 1032–1039.
    1. Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, et al. (2008) Vitamin D Deficiency and Risk of Cardiovascular Disease. Circulation 117: 503–511.
    1. Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, et al. (2008) Independent Association of Low Serum 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Levels With All-Cause and Cardiovascular Mortality. Arch Intern Med 168: 1340–1349.
    1. Sun Q, Shi L, Rimm EB, Giovannucci EL, Hu FB, et al. (2011) Vitamin D intake and risk of cardiovascular disease in US men and women. Am J Clin Nutr 94: 534–542.
    1. Hutchinson MS, Grimnes G, Joakimsen RM, Figenschau Y, Jorde R (2010) Low serum 25-hydroxyvitamin D levels are associated with increased all-cause mortality risk in a general population: the Tromsø study. Eur J Endocrinol 162: 935–942.
    1. Melamed ML, Michos ED, Post W, Astor B (2008) 25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population. Arch Intern Med 168: 1629–1637.
    1. Anderson JL, May HT, Horne BD, Bair TL, Hall NL, et al. (2010) for the Intermountain Heart Collaborative (IHC) Study Group (2010) Relation of Vitamin D Deficiency to Cardiovascular Risk Factors, Disease Status, and Incident Events in a General Healthcare Population. Am J Cardiol 106: 963–968.
    1. Ginde AA, Scragg R, Schwartz RS, Camargo CA Jr (2009) Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults. J Am Geriatr Soc 57: 1595–1603.
    1. Giovannucci E, Liu Y, Hollis BW, Rimm EB (2008) 25-Hydroxyvitmain D and Risk of Myocardial Infarction in Men. Arch Intern Med 168: 1174–1180.
    1. Lee JH, Gadi R, Spertus JA, Tang F, O'Keefe JH (2011) Prevalence of Vitamin D Deficiency in Patients With Acute Myocardial Infarction. Am J Cardiol 107: 1636–1638.
    1. Pilz S, März W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, et al. (2008) Association of Vitamin D Deficiency with Heart Failure and Sudden Cardiac Death in a Large Cross-Sectional Study of Patients Referred for Coronary Angiography. J Clin Endocrinol Metab 93: 3927–3935.
    1. Holick MF, Garabedian M (2006) Vitamin D: Photobiology, Metabolism, Mechanism of Action, and Clinical Applications. In: Favus MJ, editor. Primer on the metabolic bone diseases and disorders of mineral metabolism. pp 106–114.
    1. Holick MF, Chen TC, Lu Z, Sauter E (2007) Vitamin D and Skin Physiology: A D-Lightful Story. J Bone Miner Res 22 Suppl 2: V28–V33.
    1. Killip T 3rd, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20: 457–464.
    1. León De La Fuente R, Naesgaard PA, Nilsen ST, Woie L, Aarsland T, et al. (2011) B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina. BMC Cardiovasc Disord 11: 57 Available: . Accessed 29 Sep 2011.
    1. GRACE Investigators (2001) Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J 141: 190–199.
    1. Kuck KH, Cappato R, Siebels J, Rüppel R (2000) Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH). Circulation 102: 748–754.
    1. Müller-Bardorff M, Hallermayer K, Schröder A, Ebert C, Borgya A, et al. (1997) Improved troponin T ELISA specific for cardiac troponin T isoform: assay development and analytical and clinical validation. Clin Chem 43: 458–466.
    1. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, et al. (2002) ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation 106: 1883–1890.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir