Vitamin D and the Risk of Atrial Fibrillation - The Rotterdam Study

Abstract

Atrial fibrillation (AF) is the most common chronic arrhythmia and it increases the risk of cardiovascular morbidity and mortality. Still there is not a complete understanding of its etiology and underlying pathways. Vitamin D might regulate renin-angiotensin-aldosterone system and might be involved in inflammation, both implicated in the pathophysiology of AF. The objective of this work was to investigate the association between vitamin D status with the risk of AF in the elderly. This study was conducted within the Rotterdam Study, a community-based cohort of middle-aged and elderly participants in Rotterdam, The Netherlands. We had 3,395 participants who were free of AF diagnosis at the start of our study and who had vitamin D data available. We analyzed the association between serum 25-hydroxivitamin D (25(OH)D) and incidence of AF using Cox regression models. Vitamin D deficiency was defined as serum 25(OH)D concentrations <50nmol/l, insufficiency between 50nmol/l and 75nmol/l, while serum 25(OH)D concentrations equal to and above 75nmol/l were considered as adequate. After mean follow-up of 12.0 years 263 (7.7%) participants were diagnosed with incident AF. Vitamin D status was not associated with AF in any of the 3 multivariate models tested (model adjusted for socio-demographic factors and life-style factors: HR per 10 unit increment in serum 25(OH)D 0.96, 95% CI: 0.91-1.02; HR for insufficiency: 0.82, 95%CI: 0.60-1.11,and HR for adequate status: 0.76, 95%CI: 0.52-1.12 compared to deficiency). This prospective cohort study does not support the hypothesis that vitamin D status is associated with AF.

Effect of Plasma Level of Vitamin D on Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

“…In contrast, they did not observe an association between plasma levels of 25(OH) vitamin D3 or total 25(OH) vitamin D and the incidence of POAF. In another prospective cohort study based on the Rotterdam study, vitamin D level is not associated with AF [5] .…”

“…One of the most important mechanisms is the activation of the renin-angiotensin-aldosterone system (RAAS), as it is responsible for both structural and electrical remodeling of the atrium. Vitamin D negatively affects the RAAS, and it has antioxidant effects that reduce oxygen free radicals in the atria which are associated with inflammation and the production of proarrhythmic materials [5] .…”

Association of vitamin D deficiency with electrocardiographic markers of left atrial abnormalities

“…Low levels of serum 25(OH)D are associated with prevalent coronary heart disease (Kendrick, Targher, Smits, & Chonchol, ) as well as incident CVD (Wang et al, ). On the other hand, the association between vitamin D deficiency and atrial fibrillation (AF) is not as established; some studies reported an increased risk of AF with 25(OH)D deficiency (Chen et al, ; Ozcan, Gurlek, Gursoy, Gerede, & Erol, ) while others reported no association (Alonso et al, ; Vitezova et al, ).…”

Meta‐analysis of Vitamin D Deficiency and Risk of Atrial Fibrillation

“…Of the 8 included studies, 4 case-control studies 17 -19,23 that mainly assessed for chronic AF and were performed during winter or spring suggested that vitamin D deficiency is associated with the development of AF, whereas the remaining 4 cohort studies 16,20 -22 focused on new-onset AF, were conducted without seasonal restriction, and showed no significant association between vitamin D status and risk of AF after multivariate analysis. Five studies 16,17,19,20,22 with OR/HR values were obtained in which vitamin D levels were analyzed as a categorical variable; 8 studies 16 -23 in which vitamin D levels were analyzed as a continuous variable had been included in a separate analysis.…”

“…Five studies 16,17,19,20,22 with OR/HR values were obtained in which vitamin D levels were analyzed as a categorical variable; 8 studies 16 -23 in which vitamin D levels were analyzed as a continuous variable had been included in a separate analysis. Of the 8 included studies, 5 of them 16,17,19,20,22 analyzed vitamin D levels as both a categorical variable and continuous variable. Intriguingly, 1 study showed inconsistent results between categorical variable and continuous variable analyses, 19 and 1 study reported 2 separate results.…”