Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstrasse 11, Bad Oeynhausen, Germany.
Eur Heart J. 2013 May;34(18):1358-64. doi: 10.1093/eurheartj/ehs468. Epub 2013 Jan 12.
A significant proportion of cardiac surgical patients develop critical post-operative complications. We aimed to investigate the association of pre-operative 25-hydroxyvitamin D (25(OH)D) levels with major cardiac and cerebrovascular events (MACCE) in cardiac surgical patients.
From January 2010 to August 2011, we consecutively measured circulating 25(OH)D in 4418 operated patients. Of the study cohort, 38.0% had deficient 25(OH)D values (<30 nmol/L) and additional 32.3% had insufficient values (30-49.9 nmol/L), whereas only 3.1% had values >100 nmol/L. The incidence of MACCE was 11.5%. In multivariable-adjusted logistic regression models, the odds ratio of MACCE at deficient, inadequate, and high 25(OH)D levels was 2.23 [95% confidence interval (CI): 1.31-3.79], 1.73 (95% CI: 1.01-2.96) and 2.34 (95% CI: 1.12-4.89), respectively, compared with 25(OH)D levels of 75-100 nmol/L. A U-shaped association with circulating 25(OH)D was also present for duration of mechanical ventilatory support and intensive care unit stay. Multivariable-adjusted 6- and 12-month mortality were higher in patients with deficient 25(OH)D levels compared with patients with 25(OH)D levels of 75-100 nmol/L.
Deficient 25(OH)D levels are prevalent in cardiac surgical patients in Central Europe and are independently associated with the risk of MACCE. Further research should clarify the potential of vitamin D supplements in reducing cardiovascular risk in vitamin D-deficient patients and also the mechanisms leading to adverse effects on the cardiovascular system in the small group of patients with 25(OH)D levels >100 nmol/L.
相当比例的心脏外科患者术后出现严重并发症。我们旨在研究术前 25-羟维生素 D（25（OH）D）水平与心脏外科患者主要心脑血管事件（MACCE）的相关性。
2010 年 1 月至 2011 年 8 月，我们连续测量了 4418 例手术患者的循环 25（OH）D。在研究队列中，38.0%的患者 25（OH）D 值不足（<30 nmol/L），另有 32.3%的患者 25（OH）D 值不足（30-49.9 nmol/L），而仅有 3.1%的患者 25（OH）D 值>100 nmol/L。MACCE 的发生率为 11.5%。在多变量调整的逻辑回归模型中，25（OH）D 值不足、不足和高值时 MACCE 的比值比分别为 2.23（95%置信区间[CI]：1.31-3.79）、1.73（95%CI：1.01-2.96）和 2.34（95%CI：1.12-4.89），与 25（OH）D 水平为 75-100 nmol/L 相比。循环 25（OH）D 与机械通气支持和重症监护病房停留时间之间也存在 U 形关联。与 25（OH）D 水平为 75-100 nmol/L 的患者相比，25（OH）D 值不足的患者多变量调整后的 6 个月和 12 个月死亡率更高。
在中欧的心脏外科患者中，25（OH）D 水平不足很常见，与 MACCE 的风险独立相关。进一步的研究应该阐明维生素 D 补充剂在减少维生素 D 缺乏患者心血管风险方面的潜力，以及导致心血管系统不良影响的机制在一小部分 25（OH）D 水平>100 nmol/L 的患者中。
