血清 25-羟维生素 D、心血管风险标志物与高危社区人群中心血管疾病发病风险

Serum 25-hydroxyvitamin D, cardiovascular risk markers, and incident cardiovascular disease in a high risk community population.

机构信息

Department of Anesthesiology & Pain Medicine, University of Alberta, 2-150 Clinical Sciences Building (CSB) 8440 112 St NW, Edmonton, Alberta T6G 2G3, Canada.

Department of Community Health Sciences, Cumming School of Medicine, Teaching, Research and Wellness Building, 5E25-3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.

出版信息

Clin Biochem. 2021 Jul;93:36-41. doi: 10.1016/j.clinbiochem.2021.04.001. Epub 2021 Apr 5.

DOI:10.1016/j.clinbiochem.2021.04.001

PMID:33831385

Abstract

BACKGROUND

It is unclear whether vitamin D status is related to cardiovascular risk beyond that explained by conventional risk markers. We examined the relationship between serum 25-hydroxy (OH) vitamin D and incident cardiovascular disease (CVD; heart attack/stroke) after adjusting for individual- and community-level covariates from laboratory, administrative and survey data.

METHODS

Patients receiving their first 25-OH vitamin D test in Calgary, Alberta from 2009 to 2013 without a past CVD diagnosis but an electrocardiogram and body mass index (BMI) +/- 3 months from testing were included. The following was merged to this data: first results for laboratory-measured CVD risk markers (lipid profile, fasting plasma glucose, and HbA1c) measured +/- 3 months from testing; Census Dissemination Area (CDA)-level indicators of socioeconomic status (SES) in 2011; and CVD diagnoses > 3 months from testing between 2009 and 2016. Linear and Poisson regression were used to examine associations between 25-OH vitamin D quartile and covariates, and Cox proportional hazard models were used to examine associations with incident CVD before and after adjusting for covariates.

RESULTS

Among 72 348 patients, there were 1898 CVD events over a median of 6.0 years. Increasing quartile of 25-OH vitamin D was associated with improved lipid and glycemic profiles (p < 0.01), higher proportion of CDA-level indicators of high SES (p < 0.01), and a lower risk of CVD (Q4 vs Q1: HR: 0.72, 95% CI: 0.63-0.81, p for trend < 0.01) after adjusting for age, sex and average daily hours of sunlight during month of testing. The association with CVD was unchanged after adjusting for BMI, slightly attenuated after adjusting for SES but completely abolished after adjusting for laboratory-measured cardiovascular risk markers.

CONCLUSIONS

Vitamin D status likely offers no additional information on CVD risk over conventional laboratory-measured risk markers.

摘要

背景

目前尚不清楚维生素 D 状态与心血管疾病风险之间的关系是否超出了传统风险标志物的解释范围。我们通过调整实验室、行政和调查数据中的个体和社区水平协变量，检查了血清 25-羟维生素 D 与心血管疾病（心脏病发作/中风）发病之间的关系。

方法

2009 年至 2013 年期间，在阿尔伯塔省卡尔加里接受首次 25-羟维生素 D 检测且无既往心血管疾病诊断但心电图和身体质量指数（BMI）在检测前/后 3 个月内的患者被纳入研究。以下数据与该数据合并：检测前/后 3 个月内实验室测量的心血管疾病风险标志物（血脂谱、空腹血浆葡萄糖和 HbA1c）的首次结果；2011 年按普查区（CDA）划分的社会经济地位（SES）指标；2009 年至 2016 年期间，检测后 3 个月内的心血管疾病诊断。线性和泊松回归用于检查 25-羟维生素 D 四分位间距与协变量之间的关系，Cox 比例风险模型用于检查在调整协变量前后与心血管疾病发病的关系。

结果

在 72348 名患者中，中位随访 6.0 年期间发生了 1898 例心血管疾病事件。25-羟维生素 D 四分位间距的增加与改善的血脂和血糖谱相关（p<0.01），CDA 层面高 SES 指标的比例较高（p<0.01），且心血管疾病风险较低（Q4 与 Q1：HR：0.72，95%CI：0.63-0.81，p<0.01），调整年龄、性别和检测月份平均每日日照小时数后。在调整 BMI 后，这种与心血管疾病的关联保持不变，在调整 SES 后略有减弱，但在调整实验室测量的心血管疾病风险标志物后完全消除。