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

Abstract

BACKGROUND: Vitamin D deficiency has a pathogenetic and prognostic role in coronary artery disease. Moreover, Vitamin D has a key role in pain modulation and transmission. Diabetic patients have a high risk of silent myocardial ischemia (SMI), due to diabetic neuropathy. We aimed to evaluate the correlation between SMI and Vitamin D serum levels in a population of type 2 diabetic patients and to assess whether SMI patients had a worse survival than their symptomatic counterpart.METHODS: In this retrospective, cross-sectional, observational study, we enrolled 253 patients admitted in Policlinico of Modena Hospital and compared them with 50 healthy volunteers. We divided the 253 patients into three sub-groups: symptomatic MI group (125, 32.4%); SMI (78, 25.7%), and no-MI one (50, 41.9%). The entire population had a 25-hydroxyvitamin D (25(OH)D) measurement. RESULTS: 25(OH)D levels (nmol/l) were lower in SMI group (34.9 ± 5.8) respect to symptomatic MI (49.6 ± 6.1; p = 0.01); no MI (53.1 ± 6.2; p = 0.001) and control group (62.1 ± 6.7; p = 0.0001). 25(OH)D level was the only independent variable able to influence the development of SMI in diabetic patients, with an inverted odd-ratio of 1.11 (p = 0.01). Symptomatic MI group had better survival than SMI one (6-year survival rate: 83 vs. 69%; p = 0.01)CONCLUSIONS: Type 2 diabetic with SMI had a higher mortality risk and showed lower 25(OH)D levels than the symptomatic group. This suggests the crucial vitamin D role in the pathogenesis of SMI.