School of Nutrition, Faculty of Agriculture, The Hebrew University of Jerusalem, Rehovot, Israel.
J Clin Endocrinol Metab. 2013 May;98(5):2160-7. doi: 10.1210/jc.2013-1185. Epub 2013 Mar 26.
Low serum calcidiol has been associated with multiple comorbidities and mortality but no "safe" range has been found for the upper concentration.
We aim to establish the upper threshold of serum calcidiol, beyond which there is an increased risk for acute coronary syndrome and/or mortality.
DESIGN, SETTING, AND PARTICIPANTS: We extracted data for 1,282,822 Clalit Health Services members aged >45 between July 2007 and December 2011. Records of mortality or acute coronary syndrome were extracted during the follow-up period. Kaplan-Meier analysis calculated time to episode and Cox regression models generated adjusted hazard ratios for episode by calcidiol group (<10, 10.1-20, 20.1-36, and >36.1 ng/mL).
Acute coronary syndrome subsuming all-cause mortality.
During the 54-month study period, 422,822 Clalit Health Services members were tested for calcidiol, of which 12,280 died of any cause (905 with acute coronary syndrome) and 3933 were diagnosed with acute coronary syndrome. Compared to those with 20-36 ng/mL, the adjusted hazard ratios among those with levels of <10, 10-20, and >36 ng/mL were 1.88 (confidence interval [CI]: 1.80-1.96), 1.25 (CI: 1.21-1.30), and 1.13 (CI: 1.04-1.22) (P < .05), respectively.
The study cohort comprised only 30% of the population, those tested for vitamin D. The small sample size of those with calcidiol >36 ng/mL prevented further analysis of this group.
Vitamin D in the 20-36 ng/mL range was associated with the lowest risk for mortality and morbidity. The hazard ratio below and above this range increases significantly.
血清钙二醇浓度降低与多种合并症和死亡率相关，但尚未发现其浓度上限的“安全”范围。
我们旨在确定血清钙二醇的上限，超过该上限，急性冠状动脉综合征和/或死亡率的风险会增加。
设计、设置和参与者：我们从 2007 年 7 月至 2011 年 12 月期间，提取了超过 45 岁的 1282822 名克里利特健康服务成员的数据。在随访期间，提取了死亡率或急性冠状动脉综合征的记录。Kaplan-Meier 分析计算了发病时间，Cox 回归模型根据钙二醇组（<10、10.1-20、20.1-36 和>36.1ng/ml）生成了发病风险的调整后危险比。
急性冠状动脉综合征包括全因死亡率。
在 54 个月的研究期间，对 422822 名克里利特健康服务成员进行了钙二醇检测，其中 12280 人死于任何原因（905 人患有急性冠状动脉综合征），3933 人被诊断为急性冠状动脉综合征。与 20-36ng/ml 相比，水平<10、10-20 和>36ng/ml 的调整后危险比分别为 1.88（置信区间[CI]：1.80-1.96）、1.25（CI：1.21-1.30）和 1.13（CI：1.04-1.22）（P<0.05）。
研究队列仅包括 30%的人群，即接受维生素 D 检测的人群。钙二醇>36ng/ml 的患者样本量较小，无法进一步分析该组。
20-36ng/ml 范围内的维生素 D 与最低的死亡率和发病率相关。在此范围以下和以上的风险比显著增加。
