Article Text

  1. R Sogomonian1,
  2. H Alkhawam1,
  3. J Jolly1,
  4. N Vyas1,
  5. S Ahmad1,
  6. EA Moradoghli Haftevani2
  1. 1Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center, Elmhurst, New York, United States
  2. 2Medicine, Ross University, New Jersey, New Jersey, United States


Background Pro-atherosclerotic nature of vitamin D deficiency has been shown to increase cardiovascular events. To further demonstrate this phenomenon, we evaluated the degree of coronary artery disease (CAD) with varying levels of vitamin D.

Method A retrospective, single-center study of 9,399 patients admitted between 2005 and 2014 for chest pain who underwent coronary angiography. Patients without a vitamin D level, measured as 25-dihydroxyvitamin D (25[OH]D) were excluded from our study. 25(OH)D deficiency and insufficiency were defined by having serum concentration levels of less than 20 ng/ml and 20 to 29.9 ng/ml, respectively, while normal levels were defined as greater than or equal to 30 ng/ml. We assessed the degree of 25(OH)D and the extent of coronary disease with coronary angiography as obstructive CAD (left main stenosis of ≥50% or any stenosis of ≥70%), non-obstructive CAD (≥1 stenosis ≥20% but no stenosis ≥70%) and normal coronaries (no stenosis >20%).

Results Among 9,399 patients, 1,311 qualified, of which 308 patients (23%) had normal 25(OH)D levels, 552 patients (42%) had 25(OH)D deficiency and 451 patients (35%) had 25(OH)D insufficiency. In an analysis for the extent of coronary disease we identified 259 patients (20%) having normal coronaries, 720 patients (55%) with obstructive CAD and 291 patients (25%) with non-obstructive CAD.

Baseline clinical risk factors, and co-morbidities did not differ in either groups. Patients with 25(OH)D deficiency and insufficiency (n=1003) developed symptomatic CAD at a mean age of 63-years-old versus 67 with normal 25(OH)D (n=308, p<0.0001).

Patients with normal 25(OH)D levels were found to have normal coronaries compared to patients with 25(OH)D deficiency or insufficiency (OR: 7, 95% CI: 5.2–9.5, p<0.0001). Comparing patients with normal 25(OH)D levels, in patients with 25(OH)D deficiency or insufficiency (<29 ng/ml), 65% were found to have obstructive CAD (n=612, OR: 2.9, 95% CI: 2.3–3.7, p<0.0001) and 24% had non-obstructive CAD (n=237, OR: 1.5, 95% CI: 1.1–2, p=0.02).

In a head-to-head, sub-grouped comparison, patients with 25(OH)D deficiency and insufficiency were found to have obstructive CAD (n=394, OR: 2.7, 95% CI: 2–3.4, p<0.0001) and non-obstructive CAD (n=169, OR: 2.6, 95% CI: 2–3.4, p<0.0001), respectively.

Conclusion Vitamin D deficiency and insufficiency correlate with obstructive and non-obstructive CAD, respectively. Normal coronaries were shown to be related with normal levels of vitamin D. Vitamin D levels may provide benefit in improving risk stratification for patients with CAD as a possible modifiable risk factor. Further studies may be needed to enhance our findings.

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