Major Electrocardiographic Abnormalities and 25‐Hydroxy Vitamin D Deficiency: Insights from National Health and Nutrition Examination Survey‐III

Abstract

Background: We explored the relationship between major electrocardiogram (ECG) abnormalities (mECG) and 25-hydroxy (25-OH) vitamin D deficiency (VDD) and the effect of mECG abnormalities on all-cause and cardiovascular mortality in a healthy cohort with 25-OH vitamin D insufficiency and deficiency. Hypothesis: Lower levels of serum 25-OH vitamin D are associated with increased prevalence of mECG on resting ECG. Methods: We identified 5108 individuals from the National Health and Nutrition Examination Survey-III. mECG abnormalities included: major Q-QS wave abnormalities, ST depression/elevation, negative T waves, Wolff-Parkinson-White pattern, and ventricular conduction defect. Our cohort was divided into 3 groups based on 25-OH vitamin D levels: Group 1 (referent): >40 ng/mL; group 2 (insufficient): ≥20.01 to ≤40 ng/mL; and group 3 (deficient): ≤20 ng/mL. Logistic regression and Cox proportional hazards regression models were built. Results: The prevalence of major ECG abnormalities across 25-OH vitamin D sufficiency, insufficiency, and deficiency was 5.9%, 11%, and 13 %, respectively (P = 0.01). VDD was an independent predictor of mECG abnormalities after adjusting for traditional risk factors (continuous variable odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.97-0.99, P = 0.007; categorical variable group 3 vs group 1 OR: 2.36, 95% CI: 1.1-5.12, P = 0.03). Baseline major ECG abnormalities were predictive of long-term all-cause (hazard ratio [HR]:1.52, 95% CI: 1.23-1.89), composite cardiovascular (HR: 1.7, 95% CI: 1.34-2.15), cardiovascular (HR: 1.64, 95% CI: 1.27-2.12), and ischemic heart disease mortality (HR: 1.98, 95% CI: 1.46-2.69) in individuals with 25-OH vitamin D levels ≤40 ng/mL. Conclusions: VDD is associated with increased prevalence of major ECG abnormalities. Well-structured trials are needed to assess progression/resolution of mECG abnormalities with vitamin D supplementation in deficient individuals.

Vitamin D deficiency and electrocardiographic subclinical myocardial injury: Results from National Health and Nutrition Examination Survey‐III

“…Few studies have examined the association between vitamin D and ECG abnormalities . Tuliani et al examined the association between vitamin D levels and major ECG abnormalities and found that vitamin D deficiency (25(OH)D < 20 ng/mL) was associated with an increased prevalence of major ECG abnormalities. Zhang et al found no association between 25(OH)D and QT interval in NHANES III.…”

“…Few studies have examined the association between vitamin D and ECG abnormalities. [17][18][19] The application of CIIS in this study was to find individuals without clinical CVD but who were at an increased risk of CVD and allcause mortalities. CIIS has been shown to predict CVD and all-cause mortalities among those without apparent CVD.…”

Current Scenario of Prevalence of Vitamin D Deficiency in Ostensibly Healthy Indian Population: A Hospital Based Retrospective Study

“…Its deficiency plays an important role in the development of metabolic bone diseases like rickets and osteomalacia. Recent status of 25-hydroxy vitamin D [25(OH) vit D] has been linked with several other disorders such as metabolic syndrome, diabetes, cardiovascular diseases, autoimmune diseases such as crohn's disease, rheumatoid arthritis, infections such as tuberculosis and risk of developing cancer of breast, colon, prostate and ovary [2,4].…”

Plasma 25-hydroxyvitamin D2 and D3 levels and incidence of postoperative atrial fibrillation

“…Previous studies suggest that deficiency of total 25(OH)D is associated with increased prevalence of electrocardiographic abnormalities ( 11 ) . In a recent prospective cohort study of patients undergoing cardiac surgery, low total 25(OH)D levels were independently associated with the risk of major cardiac and cerebrovascular events (MACCE) ( 1 ) , although the investigators did not report whether a relationship existed between 25(OH)D and the development of POAF.…”