Shea M Kyla, Booth Sarah L, Weiner Daniel E, Brinkley Tina E, Kanaya Alka M, Murphy Rachel A, Simonsick Eleanor M, Wassel Christina L, Vermeer Cees, Kritchevsky Stephen B
USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA;
USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA.
J Nutr. 2017 May;147(5):888-895. doi: 10.3945/jn.117.249375. Epub 2017 Mar 29.
A role for vitamin K in coronary artery calcification (CAC), a subclinical manifestation of cardiovascular disease (CVD), has been proposed because vitamin K-dependent proteins, including the calcification inhibitor matrix Gla protein (MGP), are present in vascular tissue. Observational studies found that low circulating phylloquinone (vitamin K-1) was associated with increased CAC progression, especially in persons treated for hypertension. It is unknown whether hypertension treatment modifies this putative role of vitamin K in clinical CVD risk. We determined the association between vitamin K status and incident clinical CVD in older adults in the Health ABC (Health, Aging, and Body Composition Study) and whether the association differed by hypertension treatment status. Plasma phylloquinone was measured in 1061 participants free of CVD (70-79 y of age, 58% women, 39% black). Plasma uncarboxylated MGP [(dp)ucMGP] was measured in a subset of 635 participants. Multivariate Cox models estimated the HR for incident CVD over 12.1 follow-up years. Effect modification by hypertension was tested with the use of interaction terms. Neither low plasma phylloquinone (<0.2 nmol/L) nor elevated (dp)ucMGP (≥574 pmol/L) was significantly associated with incident CVD [respective HRs (95% CIs): 1.27 (0.75, 2.13) and 1.02 (0.72, 1.45)]. In participants treated for hypertension ( = 489; 135 events), low plasma phylloquinone was associated with higher CVD risk overall (HR: 2.94; 95% CI: 1.41, 6.13). In those with untreated hypertension ( = 153; 48 events) and without hypertension ( = 418; 92 events), low plasma phylloquinone was not associated with incident CVD. The association between high (dp)ucMGP did not differ by hypertension treatment status (-interaction = 0.72). Vitamin K status was not significantly associated with CVD risk overall, but low plasma phylloquinone was associated with a higher CVD risk in older adults treated for hypertension. Additional evidence from larger clinical studies is needed to clarify the importance of vitamin K to CVD in persons treated for hypertension, a segment of the population at high risk of clinical CVD events.
维生素K在冠状动脉钙化（CAC）（心血管疾病（CVD）的一种亚临床表型）中所起的作用已被提出，因为包括钙化抑制因子基质Gla蛋白（MGP）在内的维生素K依赖蛋白存在于血管组织中。观察性研究发现，循环叶绿醌（维生素K-1）水平低与CAC进展加快有关，尤其是在接受高血压治疗的人群中。尚不清楚高血压治疗是否会改变维生素K在临床CVD风险中的这一假定作用。我们在健康ABC研究（健康、衰老和身体成分研究）中确定了老年人维生素K状态与新发临床CVD之间的关联，以及这种关联是否因高血压治疗状态而异。对1061名无CVD的参与者（年龄70 - 79岁，58%为女性，39%为黑人）测量了血浆叶绿醌。对635名参与者的一个亚组测量了血浆未羧化MGP [（dp）ucMGP]。多变量Cox模型估计了12.1年随访期内新发CVD的风险比（HR）。通过交互项检验高血压的效应修正。血浆叶绿醌水平低（<0.2 nmol/L）和（dp）ucMGP升高（≥574 pmol/L）均与新发CVD无显著关联[各自的HR（95%CI）：1.27（0.75，2.13）和1.02（0.72，1.45）]。在接受高血压治疗的参与者中（n = 489；135例事件），血浆叶绿醌水平低总体上与较高的CVD风险相关（HR：2.94；95%CI：1.41，6.13）。在未治疗高血压的参与者中（n = 153；48例事件）和无高血压的参与者中（n = 418；92例事件），血浆叶绿醌水平低与新发CVD无关。高（dp）ucMGP之间的关联在高血压治疗状态方面无差异（交互P = 0.72）。维生素K状态总体上与CVD风险无显著关联，但血浆叶绿醌水平低与接受高血压治疗的老年人中较高的CVD风险相关。需要来自更大规模临床研究的更多证据来阐明维生素K对接受高血压治疗的人群（临床CVD事件的高风险人群）中CVD的重要性。
