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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