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: 17.33). 08/2008; 168(15):1629-37. DOI: 10.1001/archinte.168.15.1629
Source: PubMed


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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    • "a novel risk factor for all-cause mortality [3], cardiovascular mortality [4], CHD events [5] [6], stroke [7], and heart failure [8]. Suboptimal vitamin D is thought to influence CVD risk by acting on established risk factors such as hypertension, diabetes, and inflammation [9]. "

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    • "Low levels of vitamin D are a risk factor for osteoporosis, hypertension, cardiovascular disease (CVD), diabetes mellitus , infection, some autoimmune diseases, rickets, and some types of cancer [3,10e13]. In addition, low vitamin D levels are associated with high mortality [6]. An increase in vitamin D levels by 10 ng/mL was demonstrated in a meta-analysis to be associated with a decrease in mortality risk by 14% in patients with CKD [14]. "
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    • "There is also increasing evidence of a link between lower levels of vitamin D and higher risk of cancer [9] [10]. A relevant correlation between low vitamin D serum levels and a higher risk of general mortality has been confirmed by independent clinical studies after eliminating potential confounded factors [11] [12]. Additionally a recent review and meta-analysis has further confirmed the inverse association of lower vitamin D serum levels with reduced specific Table 1 Terminology for vitamin D 3 and key metabolites. "
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