Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
Am J Med. 2013 Jun;126(6):509-14. doi: 10.1016/j.amjmed.2012.11.021. Epub 2013 Apr 17.
Observational studies have suggested a strong relationship between 25(OH)D and all-cause and cardiovascular disease mortality. A few studies also have described a nonlinear trend for this relationship in population subgroups, but less is known about this relationship in healthy adults. We examined the presence of a nonlinear relationship between 25(OH)D and all-cause and cardiovascular disease mortality among healthy adults.
We examined 10,170 participants (≥18 years of age) using National Health and Nutrition Examination Survey data (2001-2004) combined with National Death Index for vital status information through December 2006. Cox proportional hazard models with spline (single knot at population median of 25[OH]D) were fit to estimate hazard ratios (HRs) for all-cause and cardiovascular disease mortality for each 10-unit increase in serum 25(OH)D. Models were adjusted for demographic and conventional cardiovascular disease risk factors.
Mean age of study participants was 46.6 (20.5) years, while median (interquartile range) 25(OH)D was 21 (15-27) ng/mL. After a median follow-up of 3.8 years (range 2.8-4.9), 509 all-cause and 184 cardiovascular diseases-related deaths were observed. In univariate analysis, 25(OH)D decreased hazards of all-cause (HR 0.59; 95% confidence interval [CI], 0.45-0.77) and cardiovascular disease (HR 0.56; 95% CI, 0.38-0.82) mortality below but not above its population median. In adjusted models, 25(OH)D retained the inverse association for all-cause (HR 0.54; 95% CI, 0.35-0.84) and cardiovascular disease (HR 0.50; 95% CI, 0.26-0.98) mortality below but not above its population median.
We found an inverse association between 25(OH)D and all-cause and cardiovascular disease mortality in healthy adults with serum 25(OH)D levels of ≤21 ng/mL. Clinical trials for the primary prevention of cardiovascular disease with 25(OH)D supplementation may target healthy adults with serum 25(OH)D levels of ≤21 ng/mL to validate these findings.
观察性研究表明 25（OH）D 与全因和心血管疾病死亡率之间存在很强的关系。一些研究还描述了人群亚组中这种关系的非线性趋势，但对于健康成年人中这种关系知之甚少。我们研究了健康成年人中 25（OH）D 与全因和心血管疾病死亡率之间是否存在非线性关系。
我们使用国家健康和营养调查数据（2001-2004 年）与国家死亡指数相结合，对 10170 名（≥18 岁）参与者进行了研究，以获取截至 2006 年 12 月的生存状态信息。使用 Cox 比例风险模型（25[OH]D 人群中位数处的单结样条）估计血清 25（OH）D 每增加 10 个单位时全因和心血管疾病死亡率的风险比（HR）。模型调整了人口统计学和传统心血管疾病危险因素。
研究参与者的平均年龄为 46.6（20.5）岁，中位数（四分位间距）25（OH）D 为 21（15-27）ng/ml。中位随访 3.8 年后（范围 2.8-4.9 年），观察到 509 例全因死亡和 184 例心血管疾病相关死亡。单变量分析显示，25（OH）D 降低了全因（HR 0.59；95%置信区间 [CI]，0.45-0.77）和心血管疾病（HR 0.56；95%CI，0.38-0.82）死亡率，但低于而不是高于其人群中位数。在调整后的模型中，25（OH）D 保留了与全因（HR 0.54；95%CI，0.35-0.84）和心血管疾病（HR 0.50；95%CI，0.26-0.98）死亡率的负相关，但低于而不是高于其人群中位数。
我们发现，在血清 25（OH）D 水平≤21ng/ml 的健康成年人中，25（OH）D 与全因和心血管疾病死亡率之间存在负相关。用 25（OH）D 补充剂进行心血管疾病一级预防的临床试验可能以血清 25（OH）D 水平≤21ng/ml 的健康成年人为目标，以验证这些发现。
