Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Division of Cardiovascular Research, Kansas City VA Medical Center, Kansas City, Missouri.
Am J Cardiol. 2022 Jun 15;173:56-63. doi: 10.1016/j.amjcard.2022.02.040. Epub 2022 Mar 31.
The effects of vitamin D (Vit-D) deficiency and Vit-D treatment (VDT) on atrial fibrillation (AF) remain inconclusive. This study sought to determine the effects of VDT and nontreatment on AF risk in Vit-D-deficient patients without a previous history of AF. In this nested case-control study, 39,845 individuals with low 25-hydroxy-Vit-D ([25-OH]D) levels (<20 ng/ml) were divided into group-A (untreated, levels ≤20 ng/ml), group-B (treated, levels 21 to 29 ng/ml), and group-C (treated, levels ≥30 ng/ml). The risk of AF was compared utilizing propensity score-weighted Cox proportional hazard models. Among the individuals receiving VDT for ≥6 months, the risk of AF was significantly lower in group-B (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80 to 0.98, p = 0.03] and group-C (HR 0.84, 95% CI 0.73 to 0.0.95, p = 0.007] than in group-A. A subgroup analysis of men >65 years showed individuals with hypertension had a significantly lower risk of AF in group-C than in group-B (HR 0.79, CI 0.65 to 0.94, p = 0.02) and group-A (HR 0.78, CI 0.64 to 0.96, p = 0.012). A similar result was found in men >65 years with diabetes mellitus in group-C compared with group-B (HR 0.69, CI 0.51 to 0.93, p = 0.012) and group-A (HR 0.63, CI 0.47 to 0.84, p = 0.002). In what is, to best of our knowledge, the largest observational study to date of patients with Vit-D deficiency and no previous history of AF, (25-OH)D level of >20 ng/ml with VDT for ≥6 months was associated with a significantly lower risk of AF. Additionally, men >65 years with hypertension or diabetes mellitus had a further decrease in AF risk when the (25-OH)D levels were ≥30 ng/ml.
维生素 D（Vit-D）缺乏和 Vit-D 治疗（VDT）对心房颤动（AF）的影响仍不确定。本研究旨在确定 Vit-D 缺乏且无 AF 既往史的患者中 VDT 和非治疗对 AF 风险的影响。在这项嵌套病例对照研究中，39845 名 25-羟维生素 D（[25-OH]D）水平低（<20ng/ml）的个体分为 A 组（未治疗，水平≤20ng/ml）、B 组（治疗，水平 21 至 29ng/ml）和 C 组（治疗，水平≥30ng/ml）。利用倾向评分加权 Cox 比例风险模型比较 AF 风险。在接受 VDT 治疗≥6 个月的个体中，B 组（风险比 [HR]0.89，95%置信区间 [CI]0.80 至 0.98，p=0.03）和 C 组（HR0.84，95%CI0.73 至 0.0.95，p=0.007）的 AF 风险明显低于 A 组。对>65 岁男性的亚组分析表明，高血压患者 C 组的 AF 风险明显低于 B 组（HR0.79，CI0.65 至 0.94，p=0.02）和 A 组（HR0.78，CI0.64 至 0.96，p=0.012）。在>65 岁男性糖尿病患者中，C 组与 B 组（HR0.69，CI0.51 至 0.93，p=0.012）和 A 组（HR0.63，CI0.47 至 0.84，p=0.002）相比，AF 风险也较低。在迄今为止我们所知的最大的 Vit-D 缺乏且无 AF 既往史患者的观察性研究中，（25-OH）D 水平>20ng/ml 并接受 VDT 治疗≥6 个月与 AF 风险显著降低相关。此外，>65 岁的高血压或糖尿病男性在（25-OH）D 水平≥30ng/ml 时，AF 风险进一步降低。
