Diabetes Mellitus and Vitamin D Deficiency: Comparable Effect on Survival and a Deadly Association after a Myocardial Infarction

Abstract

<jats:p>Survivors after a myocardial infarction (MI), especially those with diabetes mellitus (DM), remain at high risk of further events. Identifying and treating factors that may influence survival may open new therapeutic strategies. We assessed the impact on prognosis of DM and hypovitaminosis D (hypovitD), alone or combined. In this prospective, observational study, 1081 patients were enrolled surviving an MI and divided into four groups according to their diabetic and VitD status. The primary end-point was composite of all-cause mortality, angina/MI and heart failure (HF). Secondary outcomes were mortality, HF and angina/MI. During a follow-up of 26.1 months (IQR 6.6–64.5), 391 subjects experienced the primary end-point. Patients with DM or hypovitD had similar rate of the composite end-point. Patients with only hypovitD or DM did not differ regarding components of composite end-point (angina p = 0.97, HF p = 0.29, mortality p = 0.62). DM and VitD deficiency had similarly adjusted risks for primary end-point (HR 1.3, 95%CI 1.05–1.61; HR 1.3, 95% CI 1.04–1.64). The adjusted HR for primary composite end-point for patients with hypovitD and DM was 1.69 (95%CI 1.25–2.29, p = 0.001) in comparison to patients with neither hypoD nor DM. In conclusion, DM and hypovitD, individually and synergistically, are associated with a worse outcome after MI.</jats:p>

Paricalcitol Attenuates Metabolic Syndrome-Associated Heart Failure through Enhanced Mitochondrial Fusion

“…Vitamin D has been gaining attention for nonclassical roles such as regulation of inflammation, immunity, cell cycle, and metabolism. Association between vitamin D deficiency and adverse cardiometabolic outcomes has been repeatedly shown in patients, but the therapeutic role of vitamin D supplementation remains controversial [ 3 , 28 , 29 ]. Clinical studies have yielded conflicting results regarding the potential benefits of vitamin D in subjects with cardiometabolic diseases [ 30 , 31 ].…”

The Role of Exercise-Induced Molecular Processes and Vitamin D in Improving Cardiorespiratory Fitness and Cardiac Rehabilitation in Patients With Heart Failure

“…Furthermore, it has been noted that vitamin D is involved in the regulation of glucose homeostasis by stimulating insulin synthesis and its secretion and that in cases of vitamin D deficiency the insulin secretion is altered (Palomer et al, 2008). This finding is extremely important taking into consideration that vitamin D deficiency is very common among patients with DM (Aleksova et al, 2020), who have a higher tendency of developing coronary artery disease and myocardial infarction. Indeed, the elevated glucose concentration causes low-grade inflammation due to oxidative stress, leading to endothelial dysfunction and resulting in atherogenesis (De Rosa et al, 2018).…”

“…Vitamin D deficiency has been demonstrated to be associated with the risk of development and the severity of cardiovascular diseases and DM, which are both conditions characterized by intolerance to exercise and muscle fragility ( Witham, 2011 ; Lopes et al, 2014 ; Aleksova et al, 2020 ). The prevalence of vitamin D deficiency numbers more than a billion people worldwide ( Sirajudeen et al, 2019 ).…”

“…Indeed, the elevated glucose concentration causes low-grade inflammation due to oxidative stress, leading to endothelial dysfunction and resulting in atherogenesis ( De Rosa et al, 2018 ). Moreover, our group recently showed that among patients suffering from myocardial infarction, vitamin D and DM have important prognostic value, individually and synergistically, in terms of poor outcomes ( Aleksova et al, 2020 ). Therefore, is not surprising that vitamin D deficiency is associated with disease complication among patients with DM.…”

“…Therefore, is not surprising that vitamin D deficiency is associated with disease complication among patients with DM. Also, hyperglycemia stimulates RAAS and Ang II-induced expression of pro-inflammatory cytokines, which are expressed as well via the N F-κB pathway due to the deficiency of vitamin D ( Aleksova et al, 2020 ). Since in normal conditions these aspects would be suppressed, the cumulative beneficial effects of vitamin D contribute to overall health.…”