De Metrio Monica, Milazzo Valentina, Rubino Mara, Cabiati Angelo, Moltrasio Marco, Marana Ivana, Campodonico Jeness, Cosentino Nicola, Veglia Fabrizio, Bonomi Alice, Camera Marina, Tremoli Elena, Marenzi Giancarlo
From the Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy (MD, VM, MR, AC, MM, IM, JC, NC, FV, AB, MC, ET, GM); and Dipartimento di Scienze Farmacologiche e Biomolecolari, University of Milan, Italy (MC, ET).
Medicine (Baltimore). 2015 May;94(19):e857. doi: 10.1097/MD.0000000000000857.
Deficiency in 25-hydroxyvitamin D (25[OH]D), the main circulating form of vitamin D in blood, could be involved in the pathogenesis of acute coronary syndromes (ACS). To date, however, the possible prognostic relevance of 25 (OH)D deficiency in ACS patients remains poorly defined. The purpose of this prospective study was to assess the association between 25 (OH)D levels, at hospital admission, with in-hospital and 1-year morbidity and mortality in an unselected cohort of ACS patients.We measured 25 (OH)D in 814 ACS patients at hospital presentation. Vitamin D serum levels >30 ng/mL were considered as normal; levels between 29 and 21 ng/mL were classified as insufficiency, and levels < 20 ng/mL as deficiency. In-hospital and 1-year outcomes were evaluated according to 25 (OH)D level quartiles, using the lowest quartile as a reference.Ninety-three (11%) patients had normal 25 (OH)D levels, whereas 155 (19%) and 566 (70%) had vitamin D insufficiency and deficiency, respectively. The median 25 (OH)D level was similar in ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients (14.1 [IQR 9.0-21.9] ng/mL and 14.05 [IQR 9.1-22.05] ng/mL, respectively; P = .88). The lowest quartile of 25 (OH)D was associated with a higher risk for several in-hospital complications, including mortality. At a median follow-up of 366 (IQR 364-379) days, the lowest quartile of 25 (OH)D, after adjustment for the main confounding factors, remained significantly associated to 1-year mortality (P < .01). Similar results were obtained when STEMI and NSTEMI patients were considered separately.In ACS patients, severe vitamin D deficiency is independently associated with poor in-hospital and 1-year outcomes. Whether low vitamin D levels represent a risk marker or a risk factor in ACS remains to be elucidated.
25-羟维生素D（25[OH]D）是血液中维生素D的主要循环形式，其缺乏可能与急性冠状动脉综合征（ACS）的发病机制有关。然而，迄今为止，ACS患者中25（OH）D缺乏的潜在预后相关性仍不明确。这项前瞻性研究的目的是评估未选择的ACS患者队列中，入院时25（OH）D水平与住院期间及1年发病率和死亡率之间的关联。我们在814例ACS患者入院时测量了25（OH）D。血清维生素D水平>30 ng/mL被视为正常；29至21 ng/mL之间的水平被分类为不足，<20 ng/mL的水平被分类为缺乏。根据25（OH）D水平四分位数评估住院期间和1年的结局，以最低四分位数作为参考。93例（11%）患者25（OH）D水平正常，而155例（19%）和566例（70%）分别存在维生素D不足和缺乏。ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）患者的25（OH）D水平中位数相似（分别为14.1[四分位间距9.0 - 21.9] ng/mL和14.05[四分位间距9.1 - 22.05] ng/mL；P = 0.88）。25（OH）D的最低四分位数与包括死亡率在内的几种住院并发症风险较高相关。在中位随访366（四分位间距364 - 379）天期间，在对主要混杂因素进行调整后，25（OH）D的最低四分位数仍与1年死亡率显著相关（P < 0.01）。分别考虑STEMI和NSTEMI患者时也获得了类似结果。在ACS患者中，严重维生素D缺乏与不良的住院期间及1年结局独立相关。维生素D水平低在ACS中是风险标志物还是风险因素仍有待阐明。
