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Vitamin D and Cardiac Outcomes
Vitamin D Deficiency Increases Chance of Adverse Events in Cardiac Patients

The January issue of The Journal of Clinical Endocrinology published yet another study demonstrating the significant relationship between vitamin D status and clinical outcome in cardiac patients1. Following on the heels of a number of studies showing higher chances of positive outcomes for cardiac patients with sufficient vitamin D levels2,3,4, this study was designed to elucidate the relationship between excessive vitamin D levels and the risk ratio of adverse events for cardiac surgical patients.

The authors of the article, “25-Hydroxyvitamin D, 1,25-Dihydroxyvitamin D and Postoperative Outcome in Cardiac Surgery”, looked at preoperative vitamin D levels and major adverse cardiac and cerebrovascular events (MACCE) in over 3,000 cardiac surgical patients.

After performing multivariable-adjusted logistic regression analysis, the researchers found that subjects with “deficient” ( < 30nmol/L) 25-hydroxyvitamin D levels had a high odds-ratio (OR) of MACCE in comparison to the “sufficient” (75-100nmol/L) group. Specifically, the “deficient” group had an OR of 2.06 in comparison to the “sufficient” group — while the “high” 25- hydroxyvitamin D group ( > 100nmol/L) had an OR of 1.16 in comparison to the “sufficient” group.

The researchers also found that 25.1% of their subjects had “deficient” vitamin D levels, while only 4.5% had “high” levels. This is similar to the percentages noted in other studies of cardiac patients2, and understandably much higher than the rates for the rest of the population.

Additionally of note in this article: while the study did not differentiate between blood serum levels of vitamin D2 and D3, it seems that virtually all of the subjects only had vitamin D3 in their systems, not vitamin D2. This was briefly mentioned in the article during discussion on the 1,25-dihydroxyvitamin D levels, when the researchers note that only four patients had any measurable 1,25-dyhydroxyvitamin D2 in their systems.

The abstract of the article can be read here, where the full article can also be purchased or read by those with access to JCEM articles. The article may also be available for those healthcare professionals with access to Pfizer Pro.


References

1: Zittermann, A., Kuhn, J., Ernst, J. B., Becker, T., Dreier, J., Knabbe, C., … & Börgermann, J. (2014). 25- Hydroxyvitamin D, 1, 25-dihydroxyvitamin D and postoperative outcome in cardiac surgery. The Journal of Clinical Endocrinology & Metabolism, 100(1), 72-80.

2: Zittermann, A., Kuhn, J., Dreier, J., Knabbe, C., Gummert, J. F., & Börgermann, J. (2013). Vitamin D status and the risk of major adverse cardiac and cerebrovascular events in cardiac surgery. European heart journal, 34(18), 1358-1364.

3: Gotsman, I., Shauer, A., Zwas, D. R., Hellman, Y., Keren, A., Lotan, C., & Admon, D. (2012). Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. European journal of heart failure, 14(4), 357-366.

4: Dror, Y., Giveon, S. M., Hoshen, M., Feldhamer, I., Balicer, R. D., & Feldman, B. S. (2013). Vitamin D levels for preventing acute coronary syndrome and mortality: evidence of a nonlinear association. The Journal of Clinical Endocrinology & Metabolism, 98(5), 2160-2167.