Syal Sanjeev Kumar, Kapoor Aditya, Bhatia Eesh, Sinha Archana, Kumar Sudeep, Tewari Satyendra, Garg Naveen, Goel Pravin K
Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Luck now 226014, India.
J Invasive Cardiol. 2012 Aug;24(8):385-9.
Vitamin D deficiency has been linked to an increased risk of coronary artery disease (CAD) and cardiovascular (CV) death. Endothelial dysfunction plays an important role in pathogenesis of CAD and vitamin D deficiency is postulated to promote endothelial dysfunction. Despite rising trends of CAD in Asians, only limited data are available on the relationship between vitamin D, CAD, and endothelial dysfunction.
In a study of 100 patients undergoing coronary angiography, mean 25(OH)D level was 14.8 ± 9.1 ng/mL; vitamin D deficiency was present in 80% and only 7% had optimal 25(OH)D levels. Nearly one-third (36%) were severely deficient, with 25(OH)D levels <10 ng/mL. Those with vitamin D deficiency had significantly higher prevalence of double- or triple-vessel CAD (53% vs 38%), diffuse CAD (56% vs 34%), and higher number of coronary vessels involved as compared to those with higher 25(OH)D levels. Those with lower 25(OH)D levels had significantly lower brachial artery flow-mediated dilation (FMD; 4.57% vs 10.68%: P<.001) and significantly higher prevalence of impaired FMD (values <4.5%; 50.6% vs 7%; P<.002). A graded relationship between 25(OH)D levels and FMD was observed; impaired FMD was noted in 62.2%, 38.6%, and 13.3% in those with 25(OH)D levels <10 ng/mL, 10-20 ng/mL, and >20 ng/mL, respectively.
Indian patients with angiographically documented CAD frequently have vitamin D deficiency. Patients with lower 25(OH)D levels had higher prevalence of double- or triple-vessel CAD and diffuse CAD. Endothelial dysfunction as assessed by brachial artery FMD was also more frequently observed in those with low 25(OH)D levels.
维生素D缺乏与冠状动脉疾病（CAD）风险增加及心血管（CV）死亡相关。内皮功能障碍在CAD发病机制中起重要作用，且推测维生素D缺乏会促进内皮功能障碍。尽管亚洲人CAD呈上升趋势，但关于维生素D、CAD和内皮功能障碍之间关系的数据有限。
在一项对100例接受冠状动脉造影的患者的研究中，平均25（OH）D水平为14.8±9.1 ng/mL；80%存在维生素D缺乏，仅有7%的25（OH）D水平处于最佳范围。近三分之一（36%）严重缺乏，25（OH）D水平<10 ng/mL。与25（OH）D水平较高者相比，维生素D缺乏者双支或三支血管CAD患病率显著更高（53%对38%）、弥漫性CAD患病率显著更高（56%对34%），且累及的冠状动脉血管数量更多。25（OH）D水平较低者肱动脉血流介导的扩张（FMD）显著更低（4.57%对10.68%：P<0.001），FMD受损（值<4.5%）的患病率显著更高（50.6%对7%：P<0.002）。观察到25（OH）D水平与FMD之间存在分级关系；25（OH）D水平<10 ng/mL、10 - 20 ng/mL和>20 ng/mL者中FMD受损的比例分别为62.2%、38.6%和13.3%。
血管造影证实患有CAD的印度患者常存在维生素D缺乏。25（OH）D水平较低的患者双支或三支血管CAD及弥漫性CAD的患病率更高。通过肱动脉FMD评估的内皮功能障碍在25（OH）D水平低的患者中也更常见。
