Samefors M, Scragg R, Länne T, Nyström F H, Östgren C J
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
School of Population Health, University of Auckland, Auckland, New Zealand.
Diabet Med. 2017 Mar;34(3):372-379. doi: 10.1111/dme.13290. Epub 2017 Jan 19.
We aimed to explore the association between vitamin D and cardiovascular morbidity and mortality in people with Type 2 diabetes recruited from a community-based study because there is limited and inconsistent research of this group.
A prospective community-based cohort study among people aged 55-66 years with Type 2 diabetes as part of The Cardiovascular Risk in Type 2 Diabetes - A Prospective Study in Primary Care (CARDIPP). We analysed serum 25-hydroxyvitamin D [25(OH)D ] at baseline. Cox regression analyses were used to calculate hazard ratios (HR) for the first myocardial infarction, stroke or cardiovascular mortality according to 25(OH)D .
We examined 698 people with a mean follow-up of 7.3 years. Serum 25(OH)D was inversely associated with the risk of cardiovascular morbidity and mortality: HR 0.98 [95% confidence interval (CI) 0.96 to 0.99, P = 0.001]. Compared with the fourth quartile (Q4) [25(OH)D > 61.8 nmol/l], HR (with 95% CI) was 3.46 (1.60 to 7.47) in Q1 [25(OH)D < 35.5 nmol/l] (P = 0.002); 2.26 (1.01 to 5.06) in Q2 [25(OH)D 35.5-47.5 nmol/l] (P = 0.047); and 1.62 (0.70 to 3.76) in Q3 [25(OH)D 47.5-61.8 nmol/l] (P = 0.26) when adjusting for age, sex and season. The results remained significant after adjusting also for cardiovascular risk factors, physiological variables including parathyroid hormone and previous cardiovascular disease (P = 0.027).
Low 25(OH)D is associated with an increased risk of cardiovascular morbidity and mortality in people with Type 2 diabetes independent of parathyroid hormone. Vitamin D could be considered as a prognostic factor. Future studies are needed to explore whether vitamin D deficiency is a modifiable risk factor in Type 2 diabetes.
我们旨在探讨从一项基于社区的研究中招募的2型糖尿病患者维生素D与心血管疾病发病率和死亡率之间的关联，因为针对该群体的研究有限且结果不一致。
作为2型糖尿病心血管风险——初级保健前瞻性研究（CARDIPP）的一部分，在55至66岁的2型糖尿病患者中开展一项基于社区的前瞻性队列研究。我们在基线时分析血清25-羟基维生素D [25(OH)D]。采用Cox回归分析根据25(OH)D计算首次心肌梗死、中风或心血管死亡的风险比（HR）。
我们研究了698人，平均随访7.3年。血清25(OH)D与心血管疾病发病率和死亡率风险呈负相关：HR为0.98 [95%置信区间（CI）0.96至0.99，P = 0.001]。与第四四分位数（Q4）[25(OH)D > 61.8 nmol/l]相比，在第一四分位数（Q1）[25(OH)D < 35.5 nmol/l]中，调整年龄、性别和季节后HR（及其95%CI）为3.46（1.60至7.47）（P = 0.002）；在第二四分位数（Q2）[25(OH)D 35.5 - 47.5 nmol/l]中为2.26（1.01至5.06）（P = 0.047）；在第三四分位数（Q3）[25(OH)D 47.5 - 61.8 nmol/l]中为1.62（0.70至3.76）（P = 0.26）。在进一步调整心血管危险因素、包括甲状旁腺激素在内的生理变量以及既往心血管疾病后，结果仍然显著（P = 0.027）。
低水平的25(OH)D与2型糖尿病患者心血管疾病发病率和死亡率风险增加相关，且独立于甲状旁腺激素。维生素D可被视为一种预后因素。未来需要开展研究以探讨维生素D缺乏是否是2型糖尿病中一个可改变的危险因素。
