25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population

Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Ullmann 615, Bronx, NY 10461, USA.
Archives of internal medicine (Impact Factor: 13.25). 08/2008; 168(15):1629-37. DOI: 10.1001/archinte.168.15.1629
Source: PubMed

ABSTRACT In patients undergoing dialysis, therapy with calcitriol or paricalcitol or other vitamin D agents is associated with reduced mortality. Observational data suggests that low 25-hydroxyvitamin D levels (25[OH]D) are associated with diabetes mellitus, hypertension, and cancers. However, whether low serum 25(OH)D levels are associated with mortality in the general population is unknown.
We tested the association of low 25(OH)D levels with all-cause, cancer, and cardiovascular disease (CVD) mortality in 13 331 nationally representative adults 20 years or older from the Third National Health and Nutrition Examination Survey (NHANES III) linked mortality files. Participant vitamin D levels were collected from 1988 through 1994, and individuals were passively followed for mortality through 2000.
In cross-sectional multivariate analyses, increasing age, female sex, nonwhite race/ethnicity, diabetes, current smoking, and higher body mass index were all independently associated with higher odds of 25(OH)D deficiency (lowest quartile of 25(OH)D level, <17.8 ng/mL [to convert to nanomoles per liter, multiply by 2.496]), while greater physical activity, vitamin D supplementation, and nonwinter season were inversely associated. During a median 8.7 years of follow-up, there were 1806 deaths, including 777 from CVD. In multivariate models (adjusted for baseline demographics, season, and traditional and novel CVD risk factors), compared with the highest quartile, being in the lowest quartile (25[OH]D levels <17.8 ng/mL) was associated with a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%. The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.
The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population.

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Available from: Michal Melamed, Dec 25, 2013
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    • "In fact, epidemiological data show that vitamin D levels are substantially decreased in patients with HF, compared with controls [3] [4]. In different cohorts, it was confirmed that higher vitamin D levels are associated with more favorable outcomes in patients with HF [5]. "
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    ABSTRACT: Background Low plasma vitamin D levels have been associated with heart failure (HF). This research attempts to explain the role of vitamin D supplementation on myocardial function in elderly patients with HF. Methods and results Twenty-three chronic HF patients were randomized in a small parallel group, double-blind, placebo-controlled trial. All patients, with a mean age of 74 years and vitamin D levels < 30 ng/mL, received 800,000 IU (4,000 IU/daily) of cholecalciferol or placebo for six months. The outcomes measured at baseline and after six months were ejection fraction (EF) and other echocardiography parameters, carboxyterminal propeptide of procollagen type I (PIP), natriuretic peptides, lipid profile, renin, parathyroid hormone, blood pressure and body mass index (BMI). In 13 patients under active treatment for six months, mean plasma 25-hydroxy vitamin D concentrations (15.51 versus -1.40 ng/mL, p<0.001) and plasma calcium (from 9.3 to 9.6 mmol/L, p< 0.05) increased significantly. However, other biomarkers of bone metabolism did not differ between the treatment and placebo groups. EF increased significantly in the intervention group (6.71 versus -4.3 %; p < 0.001), and the serum concentration of PIP increased only in the placebo group after six months (1,140.98 versus -145 mcg/L; p < 0.05). Systolic blood pressure was lower after six months of cholecalciferol treatment (from 129.6 to 122.7 mm Hg, p < 0.05). No significant variations were observed for other parameters. Conclusions Six months of vitamin D supplementation significantly improves ejection fraction in elderly patients with heart failure and vitamin D deficiency.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 08/2014; 24(8). DOI:10.1016/j.numecd.2014.02.015 · 3.88 Impact Factor
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    • "Recently, numerous observational and epidemiological studies suggest that vitamin D deficiency may be related to CVD and mortality [3] [4] [5] [6] [7] [8] [9] and is associated with myocardial infarction (MI) [10] [11] and sudden cardiac death (SCD) [12]. As vitamin D deficiency in men and women is increasing, we believe that the general diet does not contain a sufficient "
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    ABSTRACT: Vitamin D may not only reflect disease but may also serve as a prognostic indicator. Our aim was to assess the gender-specific utility of vitamin D measured as 25-hydroxy-vitamin D [25(OH)D] to predict all-cause and cardiac death in patients with suspected acute coronary syndrome (ACS) and to compare its prognostic utility to brain natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hsCRP). Blood samples were harvested on admission in 982 patients. Forty percent were women (65.9 ± 12.6 years). Mortality was evaluated in quartiles of 25(OH)D, BNP, and hsCRP, respectively, during a 5-year follow-up, applying univariate and multivariate analyses. One hundred and seventy-three patients died; 78 were women. In 92 patients (37 women), death was defined as cardiac. In women, the univariate hazard ratio (HR) for total death of 25(OH)D in Quartile (Q) 2 versus Q1, Q3 versus Q1, and Q4 versus Q1 was 0.55 (95% CI 0.33-0.93), 0.29 (95% CI 0.15-0.55), and 0.13 (95% CI 0.06-0.32), respectively. In females, it was an independent predictor of total and cardiac death, whereas BNP and hsCRP were less gender-specific. No gender differences in 25(OH)D were noted in a reference material. Accordingly, vitamin D independently predicts mortality in females with suspected ACS.
    11/2013; 2013:398034. DOI:10.1155/2013/398034
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    • "Obesity is a growing health concern worldwide and is a major cause of morbidity and mortality. Recent studies have suggested that vitamin D deficiency is associated with cardiometabolic risk factors, including obesity, autoimmune diseases, cancer, and insulin resistance [1] [2]. Furthermore, low 25(OH)D levels have been shown to be associated with higher rates of myocardial infarction and diabetes [3] [4] [5], and the incidence of hypertension has been found to increase in association with low vitamin D levels [6]. "
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    ABSTRACT: Obesity-related diseases are becoming the most important causes of mortality worldwide. Several studies have suggested an association between low levels of vitamin D and obesity. In addition, plasma adiponectin levels have been found to be lower in obese subjects. We evaluated the association of metabolic risk factors with both adiponectin and vitamin D levels and that between adiponectin and vitamin D levels. The study consisted of 114 obese and healthy subjects. 25-Hydroxy vitamin D [25(OH)D] levels were positively correlated with adiponectin and HDL-cholesterol (HDL-C) and inversely correlated with body mass index (BMI), LDL-cholesterol (LDL-C), total cholesterol (T-C), triglyceride (TG), fasting glucose, homeostasis model assessment of insulin resistance (HOMA index), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The mean 25(OH)D levels in the obese and nonobese groups were 22.5 ± 5.7 and 32.3 ± 5.8 ng/mL, respectively (P < 0.0001). The mean adiponectin level in the obese group was lower than that in the nonobese group (P < 0.0001). Lower vitamin D and adiponectin levels were strongly associated with metabolic risk factors and obesity in Turkish children and adolescents.
    International Journal of Endocrinology 07/2013; 2013:503270. DOI:10.1155/2013/503270 · 1.52 Impact Factor
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