University of Alabama at Birmingham, 35294-0007, USA.
Am Heart J. 2012 Sep;164(3):387-93. doi: 10.1016/j.ahj.2012.06.016.
This post hoc nested case-control analysis of the TNT study was designed to investigate whether baseline vitamin D level is a significant predictor of cardiovascular risk among statin-treated patients and whether changes in vitamin D after treatment with atorvastatin are associated with improved cardiovascular outcomes.
A total of 10,001 patients with stable coronary heart disease were randomized to atorvastatin 80 or 10 mg for a median of 4.9 years. This analysis included 1,509 patients (497 with a subsequent cardiovascular event and 1,012 without an event) with vitamin D levels determined at baseline and 1 year. Event rates were analyzed by Cox proportional hazard model by baseline vitamin D levels, with vitamin D as a continuous variable, and with change in vitamin D level as the predictor.
Vitamin D deficiency (<15 ng/mL) or insufficiency (15- <30 ng/mL) was present in 108 (7.2%) of 1,509 and 625 (41.4%) of 1,509 of patients, whereas 46 (3.0%) of 1,509 had elevated vitamin D. There was no relationship between baseline vitamin D levels or change in vitamin D levels and cardiovascular events or mortality. Modeling of events with vitamin D as a continuous variable similarly showed no relationship of vitamin D to events. These findings held true after adjustment for seasonal variations in vitamin D and other confounders.
In statin-treated patients with stable coronary heart disease, vitamin D levels did not predict cardiovascular risk. Changes in plasma concentrations of vitamin D after 1 year of treatment made no contribution to the efficacy of atorvastatin therapy.
本 TNT 研究事后嵌套病例对照分析旨在探讨基线维生素 D 水平是否是他汀类药物治疗患者心血管风险的重要预测因素，以及阿托伐他汀治疗后维生素 D 的变化是否与心血管结局改善相关。
共有 10001 例稳定性冠心病患者被随机分为阿托伐他汀 80 或 10 mg 治疗，中位随访时间为 4.9 年。本分析纳入了基线和 1 年时检测了维生素 D 水平的 1509 例患者（497 例发生后续心血管事件，1012 例未发生事件）。通过 Cox 比例风险模型分析按基线维生素 D 水平、维生素 D 作为连续变量以及维生素 D 水平变化作为预测因素的事件发生率。
1509 例患者中有 108 例（7.2%）存在维生素 D 缺乏症（<15ng/mL）或不足症（15-<30ng/mL），1509 例患者中有 625 例（41.4%）存在维生素 D 水平升高，46 例（3.0%）。基线维生素 D 水平或维生素 D 水平变化与心血管事件或死亡率之间无相关性。维生素 D 作为连续变量进行事件建模同样显示维生素 D 与事件之间无关系。这些发现经调整维生素 D 的季节性变化和其他混杂因素后仍然成立。
在稳定性冠心病的他汀类药物治疗患者中，维生素 D 水平不能预测心血管风险。阿托伐他汀治疗 1 年后血浆维生素 D 浓度的变化对其疗效没有贡献。
