Wu Zhenqiang, Sluyter John, Liew Oi Wah, Chong Jenny Pek Ching, Waayer Debbie, Camargo Carlos A, Richards A Mark, Scragg Robert
School of Population Health, University of Auckland, Auckland, New Zealand; Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.
School of Population Health, University of Auckland, Auckland, New Zealand.
J Steroid Biochem Mol Biol. 2022 Jun;220:106093. doi: 10.1016/j.jsbmb.2022.106093. Epub 2022 Mar 7.
The effects of vitamin D supplementation on cardiovascular diseases are controversial. Data on effects of vitamin D upon cardiac biomarkers, as surrogate endpoints of cardiovascular diseases, are limited and inconclusive. Therefore, we carried out a post-hoc analysis of sub-samples of a randomized, double-blinded, placebo-controlled trial with community-based older adults who were randomized to receive monthly 100,000-IU vitamin D or placebo, to determine effect of monthly vitamin D supplementation on high-sensitivity cardiac troponin I (hs-cTnI), troponin T (hs-cTnT) and N-terminal-pro-B-type natriuretic peptide (NT-proBNP). Adjusted relative difference (aRD) of follow-up geometric mean of biomarkers and adjusted relative risk (aRR) of elevated biomarkers between two groups were calculated. A total of 779 participants aged 50-84 y, randomized to vitamin D (n = 395) or placebo (n = 384) groups underwent sampling for measurement of plasma biomarkers at baseline and after one or two years treatment. Over a mean follow-up of 1.6 years, we did not find significant relative difference of geometric mean levels of three biomarkers at follow-up between vitamin D and placebo groups: hs-cTnI (aRD=1.03, 95%CI=0.97-1.09), hs-cTnT (aRD=0.99, 95%CI=0.95-1.04), and NT-proBNP (aRD=1.01, 95%CI=0.92-1.10). No significant differences were found in likelihood of clinically elevated biomarkers between two groups: hs-cTnI (aRR=0.92, 95%CI=0.51-1.69), hs-cTnT (aRR=1.11, 95%CI=0.86-1.42), and NT-proBNP (aRR=1.03,95%CI=0.89-1.20). However, among participants with initial low vitamin D status (<50 nmol/L, n = 200), follow-up NT-proBNP were significantly lower in the vitamin D group compared to placebo (geometric mean 75.9 vs 94.5 pg/mL, respectively; aRD=0.84, 95%CI=0.71-<1.00). The same results were observed for the NT-proBNP levels change from baseline between two groups. Overall, in older adults, monthly vitamin D supplementation did not reduce concentrations of hs-cTnI, hs-cTnT, and NT-proBNP. In those with low vitamin D status, vitamin D treatment was associated, on follow up and change from baseline, with lower plasma NT-proBNP compared with placebo. This potentially signals reduced risk of subsequent heart failure within this sub-group. However, we acknowledge that these findings need to be considered exploratory. Further research is required to replicate them.
补充维生素D对心血管疾病的影响存在争议。关于维生素D对作为心血管疾病替代终点的心脏生物标志物的影响的数据有限且尚无定论。因此，我们对一项针对社区老年人的随机、双盲、安慰剂对照试验的子样本进行了事后分析，这些老年人被随机分为每月接受100,000国际单位维生素D或安慰剂组，以确定每月补充维生素D对高敏心肌肌钙蛋白I（hs-cTnI）、肌钙蛋白T（hs-cTnT）和N末端B型脑钠肽原（NT-proBNP）的影响。计算了两组生物标志物随访几何平均值的调整相对差异（aRD）以及生物标志物升高的调整相对风险（aRR）。共有779名年龄在50 - 84岁的参与者，随机分为维生素D组（n = 395）或安慰剂组（n = 384），在基线以及治疗一年或两年后进行血浆生物标志物测量的采样。在平均1.6年的随访中，我们未发现维生素D组和安慰剂组在随访时三种生物标志物的几何平均水平存在显著相对差异：hs-cTnI（aRD = 1.03，95%CI = 0.97 - 1.09）、hs-cTnT（aRD = 0.99，95%CI = 0.95 - 1.04）和NT-proBNP（aRD = 1.01，95%CI = 0.92 - 1.10）。两组之间临床生物标志物升高的可能性未发现显著差异：hs-cTnI（aRR = 0.92，95%CI = 0.51 - 1.69）、hs-cTnT（aRR = 1.11，95%CI = 0.86 - 1.42）和NT-proBNP（aRR = 1.03，95%CI = 0.89 - 1.20）。然而，在初始维生素D水平较低（<50 nmol/L，n = 200）的参与者中，与安慰剂相比，维生素D组的随访NT-proBNP显著更低（几何平均值分别为75.9与94.5 pg/mL；aRD = 0.84，95%CI = 0.71 - <1.00）。两组之间NT-proBNP水平相对于基线的变化也观察到了相同结果。总体而言，在老年人中，每月补充维生素D并未降低hs-cTnI、hs-cTnT和NT-proBNP的浓度。在维生素D水平较低的人群中，与安慰剂相比，维生素D治疗在随访以及相对于基线的变化方面，与较低的血浆NT-proBNP相关。这可能表明该亚组中后续心力衰竭风险降低。然而，我们承认这些发现需要被视为探索性的。需要进一步研究来重复验证。
