Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Am Heart J. 2010 Jun;159(6):1044-51. doi: 10.1016/j.ahj.2010.03.031.
Recent longitudinal analyses suggested that low levels of serum 25-hydroxyvitamin D (25-OH-D) predict incident cardiovascular disease in initially healthy populations. Because the prognostic value of vitamin D for the occurrence of secondary cardiovascular events remains unclear, we examined the association of baseline 25-OH-D levels with prognosis in patients with stable coronary heart disease (CHD).
Serum 25-OH-D levels from 1,125 CHD patients of 2 German clinics undergoing a 3-week rehabilitation program after an acute cardiovascular event were measured, and participants were followed for up to 8 years. We used multivariate Cox regression analysis to model cardiovascular event incidence (fatal and nonfatal, including myocardial infarction, stroke, and death due to cardiovascular diseases) and all-cause mortality according to 25-OH-D quartiles, categories based on cut points of 15 and 30 ng/mL, or continuous vitamin D concentrations.
During follow-up, 148 cardiovascular events and 121 deaths were recorded. Elevation of risk for the lowest quartile or category in comparison to the highest category was weak and nonsignificant for both incidence (hazard ratio HR = 1.15 [0.72-1.84], HR(<15 ng/mL) = 1.17 [0.61-2.23]) and mortality (HR(quartile1) = 1.29 [0.77-2.14], HR(<15 ng/mL) = 1.87 [0.91-3.82]) in unadjusted Cox regression analysis and disappeared entirely after adjustment for potential confounders (cardiovascular events: HR(quartile1) = 0.84 [0.47-1.50], HR(<15 ng/mL) = 0.90 [0.41-1.96]; mortality: HR(quartile1) = 0.63 [0.33-1.21], HR(<15 ng/mL) = 0.93 [0.39-2.21]). Models treating vitamin D as a continuous variable likewise suggested no significant associations.
Unlike previous population-based studies, our analysis in high-risk patients with stable CHD does not support a prognostic value of baseline-25-OH-D levels for secondary cardiovascular event incidence or all-cause mortality.
最近的纵向分析表明，血清 25-羟维生素 D（25-OH-D）水平低预示着最初健康人群中心血管疾病的发生。由于维生素 D 对二级心血管事件发生的预后价值尚不清楚，我们研究了基线 25-OH-D 水平与稳定型冠心病（CHD）患者预后的关系。
对 2 家德国诊所的 1125 例 CHD 患者在急性心血管事件后接受为期 3 周的康复治疗期间的血清 25-OH-D 水平进行了测量，并对患者进行了长达 8 年的随访。我们使用多变量 Cox 回归分析，根据 25-OH-D 四分位数、15 和 30ng/ml 截点分类或连续维生素 D 浓度，对心血管事件（致死性和非致死性，包括心肌梗死、卒中和心血管疾病导致的死亡）和全因死亡率进行建模。
在随访期间，记录了 148 例心血管事件和 121 例死亡。与最高四分位数或类别相比，最低四分位数或类别发生风险的升高微弱且无统计学意义，无论是在发病风险（四分位 1 时 HR（1）=1.15[0.72-1.84]，HR（<15ng/ml）=1.17[0.61-2.23]）还是死亡率（四分位 1 时 HR（1）=1.29[0.77-2.14]，HR（<15ng/ml）=1.87[0.91-3.82]）方面，在未调整的 Cox 回归分析中均无统计学意义，并且在调整潜在混杂因素后完全消失（心血管事件：HR（1）=0.84[0.47-1.50]，HR（<15ng/ml）=0.90[0.41-1.96]；死亡率：HR（1）=0.63[0.33-1.21]，HR（<15ng/ml）=0.93[0.39-2.21]）。将维生素 D 视为连续变量的模型也提示无显著相关性。
与以前的基于人群的研究不同，我们对稳定型 CHD 高危患者的分析不支持基线 25-OH-D 水平对二级心血管事件发生率或全因死亡率的预后价值。
