Verdoia M, Schaffer A, Barbieri L, Di Giovine G, Marino P, Suryapranata H, De Luca G
Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands.
Nutr Metab Cardiovasc Dis. 2015 May;25(5):464-70. doi: 10.1016/j.numecd.2015.01.009. Epub 2015 Feb 7.
There has been a surge of interest in the cardiovascular effects of vitamin D (25(OH)D), preventing the processes leading to vascular wall degeneration and coronary artery disease (CAD). Gender differences have been suggested for vitamin D status, with a higher rate of deficiency occurring especially in post-menopausal women, increasing the risk of bone fractures and osteoporosis. However, to date, few studies have evaluated the differences in 25(OH)D levels according to gender and their impact on the extent of CAD, which was therefore the aim of the present study.
In patients undergoing coronary angiography, fasting samples were collected for the assessment of 25(OH)D levels. Significant CAD was defined as at least one vessel stenosis >50%, while severe CAD was defined as left main and/or three-vessel disease. Of the 1811 patients included, 530 (29.3%) were females, who displayed older age (p < 0.001), higher rate of renal failure (p < 0.001), hypertension (p = 0.05), treatment with angiotensin-receptor blockers (p = 0.03) and diuretics (p < 0.001), acute presentation (p < 0.001), higher platelet count (p < 0.001), glycosylated haemoglobin (p = 0.02) and cholesterol (p = 0.001), but an inverse relationship with smoking (p < 0.001), previous cardiovascular events (p < 0.001), treatment with statins and acetylsalicylic acid (ASA) (p < 0.001), body mass index (p = 0.002), haemoglobin (p < 0.001), leucocytes (p = 0.03) and triglycerides (p < 0.001). Female gender was associated with lower vitamin D levels (14.5 ± 10.9 vs. 15.9 ± 9.5, p = 0.007) and independently associated with severe vitamin D deficiency (41.9% vs. 30.4%, p < 0.001; adjusted odds ratio (OR) (95% confidence interval (CI)) = 1.42 (1.08-1.87), p = 0.01). Lower tertiles of vitamin D were associated with an increased prevalence and severity of CAD in females (adjusted OR (95% CI = 1.26 (1.10-1.44), p = 0.001 for CAD; adjusted OR (95% CI) = 1.6 (1.39-1.87), p < 0.001 for severe CAD). In males, vitamin D status was independently related to the prevalence (adjusted OR (95% CI) = 1.28 (1.02-1.61), p = 0.03) of CAD, but not the extent of CAD (adjusted OR (95% CI) = 1.02 (0.86-1.2), p = 0.84).
Gender significantly affects vitamin D status. The lower 25(OH)D levels observed in females, as compared to males, play a more relevant role in conditioning the severity of CAD.
维生素D（25羟维生素D）对心血管系统的影响引发了广泛关注，它可预防导致血管壁退变和冠状动脉疾病（CAD）的进程。已有研究表明维生素D状态存在性别差异，尤其是绝经后女性维生素D缺乏率更高，这增加了骨折和骨质疏松的风险。然而，迄今为止，很少有研究评估25羟维生素D水平在性别上的差异及其对CAD严重程度的影响，因此本研究旨在对此进行探讨。
对接受冠状动脉造影的患者采集空腹样本以评估25羟维生素D水平。显著CAD定义为至少一支血管狭窄>50%，严重CAD定义为左主干和/或三支血管病变。在纳入的1811例患者中，530例（29.3%）为女性，她们年龄更大（p<0.001），肾衰竭发生率更高（p<0.001）、高血压发生率更高（p=0.05），接受血管紧张素受体阻滞剂治疗（p=0.03）和利尿剂治疗（p<0.001），急性发病（p<0.001），血小板计数更高（p<0.001）、糖化血红蛋白水平更高（p=0.02）和胆固醇水平更高（p=0.001），但与吸烟呈负相关（p<0.001）、既往心血管事件发生率更低（p<0.001），接受他汀类药物和阿司匹林（ASA）治疗的比例更低（p<0.001），体重指数更低（p=0.002）、血红蛋白水平更低（p<0.001）、白细胞计数更低（p=0.03）和甘油三酯水平更低（p<0.001）。女性的维生素D水平较低（14.5±10.9 vs. 15.9±9.5，p=0.007），且与严重维生素D缺乏独立相关（41.9% vs. 30.4%，p<0.001；校正比值比（OR）（95%置信区间（CI））=1.42（1.08 - 1.87），p=0.01）。维生素D水平处于较低三分位数与女性CAD的患病率和严重程度增加相关（CAD的校正OR（95%CI）=1.26（1.10 - 1.44），p=0.001；严重CAD的校正OR（95%CI）=1.6（1.39 - 1.87），p<0.001）。在男性中，维生素D状态与CAD的患病率独立相关（校正OR（95%CI）=1.28（1.02 - 1.61），p=0.03），但与CAD的严重程度无关（校正OR（95%CI）=1.02（0.86 - 1.2），p=0.84）。
性别显著影响维生素D状态。与男性相比，女性较低的25羟维生素D水平在决定CAD严重程度方面发挥着更重要的作用。
