The association between vitamin D status and clinical events in high-risk older patients with non-ST elevation acute coronary syndrome undergoing invasive management

Abstract

There is a higher incidence of vitamin D deficiency in older adults. This may play a plausible mechanistic role in the occurrence of increased adverse events after non-ST elevation acute coronary syndrome (NSTEACS). This study investigated whether total vitamin D levels at the time of presentation predicted adverse outcomes in older adults undergoing invasive management of NSTEACS. Of the 629 patients screened, 300 high-risk older adults with NSTEACS managed by an invasive strategy were recruited. Serum total 25-hydroxyvitamin D was measured at index presentation. The primary outcome was defined as 1-year composite of all-cause mortality, acute coronary syndrome (ACS), unplanned repeat revascularisation, significant bleeding or stroke. Mean age was 80.5±4.8 years (61.9% male). Median vitamin D level was 29.5nmol/L [interquartile range IQR 16.0–53.0 nmol/L] and was split equally by the median for analysis forming two groups: high (median vitamin D 53.0 nmol/L [IQR 40.0–75.0]) and low (16.0 nmol/L [11.0–23.0]). The primary outcome occurred in 76 patients (25.9%); 32 (21.9%) in the low group and 44 (29.9%) in the high group, p = 0.12. Multivariable analyses showed no significant difference in the primary composite outcome at 1 year between the low and high group of baseline serum vitamin D (Hazard Ratio 1.20 [95% Confidence Interval 0.72–2.0], p = 0.48). Serum total vitamin D, measured at the time of angiography, was not associated with adverse outcomes at one year in this high-risk older cohort of patients with NSTEACS undergoing invasive management.

Predictive value of 25-hydroxyvitamin D level in patients with coronary artery disease: A meta-analysis

“…All articles adopted the prospective designs. Four studies ( 10 , 11 , 17 , 21 ) included patients with ACS, one study ( 22 ) enrolled patients with post-acute myocardial infarction (AMI), one study ( 13 ) included stable angina patients, and others did not report the specific type of CAD. Sample sizes ranged from 252 to 4,114, with a total of 17,892 patients with CAD.…”

“…Seven studies ( 10 , 11 , 14 – 16 , 21 – 23 ) evaluated the value of 25-hydroxyvitamin D level in predicting MACEs. Figure 4 provides a pooling risk estimate of the association between d-dimer level and MACEs.…”

“…After reading the titles and abstracts, 597 obviously unrelated records were excluded. Thirty-five articles were retrieved for full-text assessment, and 13 studies (9)(10)(11)(12)(13)(14)(15)(16)(17)(20)(21)(22)(23) satisfied the inclusion criteria (Figure 1).…”

Low Levels of Vitamin D and Silent Myocardial Ischemia in Type 2 Diabetes: Clinical Correlations and Prognostic Significance

“…It is estimated that 1 billion people worldwide suffer from vitamin D deficiency [ 3 ]: more than 40% of the USA and European populations and even 80% of the Italian population suffer from this [ 4 , 5 ]. Low 25(OH)D levels were associated with cardiovascular disorders, including heart failure, stroke, and, especially, coronary heart disease (CAD) [ 6 , 7 , 8 , 9 , 10 ]. Moreover, 25(OH)D deficiency was associated with endothelial dysfunction, subclinical atherosclerosis, a significant reduction in coronary flow reserve [ 11 , 12 ], and sub-epicardial ischemia in patients hospitalized for the acute coronary syndrome [ 13 ].…”

Vitamin D Low-Levels and Silent Myocardial Ischemia in Type 2 Diabetes: Clinical Correlations and Prognostic Significance

“…Low 25 (OH) D levels were associated with cardiovascular disorders, including heart failure, stroke, and especially coronary heart disease (CAD) (6)(7)(8)(9)(10). Besides, 25(OH)D de ciency was associated with endothelial dysfunction, subclinical atherosclerosis, signi cant reduction of coronary ow reserve (11,12), and sub-epicardial ischemia in patients hospitalized for the acute coronary syndrome (13).…”