2 型糖尿病患者的维生素 D 状态、遗传因素与心血管疾病风险：一项前瞻性研究。
Vitamin D status, genetic factors, and risks of cardiovascular disease among individuals with type 2 diabetes: a prospective study.
机构信息
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Am J Clin Nutr. 2022 Nov;116(5):1389-1399. doi: 10.1093/ajcn/nqac183. Epub 2023 Feb 10.
BACKGROUND
The presence of a threshold effect has been proposed, suggesting that beneficial effects from vitamin D supplementation may only be present when the vitamin D concentration is below a particular threshold.
OBJECTIVES
We investigated the associations of serum 25-hydroxyvitamin D [25(OH)D] concentrations and genetic factors with risks of total and subtypes of cardiovascular disease (CVD) in individuals with type 2 diabetes (T2D), among whom vitamin D deficiency or insufficiency is particularly common.
METHODS
This prospective study included 15,103 individuals with T2D who were initially free of CVD and had serum 25(OH)D measurements in the UK Biobank. Incidences of total and subtypes of CVD, including ischemic heart disease (IHD) and stroke, were ascertained via electronic health records. Weighted genetic risk scores (GRSs) were constructed for IHD and stroke.
RESULTS
The mean serum 25(OH)D concentration was 43.4 nmol/L (SD: 20.4 nmol/L), and 65.7% of participants had a vitamin D concentration below 50 nmol/L. During a median of 11.2 years of follow-up, 3534 incident CVD events were documented. Compared with individuals with 25(OH)D concentrations <25 nmol/L, participants with 25(OH)D concentrations ≥75 nmol/L had HRs (95% CIs) of 0.75 (0.64, 0.88) for CVD, 0.69 (0.56, 0.84) for IHD, and 0.74 (0.52, 1.06) for stroke. Participants with 25(OH)D concentrations ≥50 nmol/L and low GRSs, as compared with individuals with 25(OH)D concentrations <25 nmol/L and high GRSs, had a 50% (39%, 65%) lower risk of IHD. No significant interactions were demonstrated between serum 25(OH)D concentrations and the GRSs and genetic variants in vitamin D receptors (VDR).
CONCLUSIONS
Higher serum 25(OH)D concentrations were significantly associated with lower risks of total CVD and IHD among patients with T2D, regardless of their genetic susceptibility and the genetic variants in VDR. Risk reductions tended to plateau at serum 25(OH)D levels around 50 nmol/L. These findings suggest that maintaining an adequate vitamin D status and avoiding deficiency may help to prevent CVD complications among patients with T2D.
背景
已经提出了阈值效应的存在，表明维生素 D 补充的有益效果可能仅在维生素 D 浓度低于特定阈值时才存在。
目的
我们研究了血清 25-羟维生素 D [25(OH)D] 浓度和遗传因素与 2 型糖尿病（T2D）患者心血管疾病（CVD）总发病率和各亚型发病率之间的相关性，在这些患者中，维生素 D 缺乏或不足尤为常见。
方法
这项前瞻性研究纳入了英国生物银行中 15103 例最初无 CVD 且血清 25(OH)D 可测量的 T2D 患者。通过电子健康记录确定 CVD 总发病率和各亚型发病率，包括缺血性心脏病（IHD）和中风。为 IHD 和中风构建了加权遗传风险评分（GRS）。
结果
平均血清 25(OH)D 浓度为 43.4 nmol/L（标准差：20.4 nmol/L），65.7%的参与者维生素 D 浓度低于 50 nmol/L。在中位数为 11.2 年的随访期间，共记录到 3534 例 CVD 事件。与 25(OH)D 浓度<25 nmol/L 的患者相比，25(OH)D 浓度≥75 nmol/L 的患者 CVD 的 HR（95%CI）为 0.75（0.64，0.88），IHD 为 0.69（0.56，0.84），中风为 0.74（0.52，1.06）。与 25(OH)D 浓度<25 nmol/L 且 GRS 较高的患者相比，25(OH)D 浓度≥50 nmol/L 且 GRS 较低的患者发生 IHD 的风险降低 50%（39%，65%）。未观察到血清 25(OH)D 浓度与 GRS 和维生素 D 受体（VDR）的遗传变异之间存在显著的交互作用。
结论
在 T2D 患者中，较高的血清 25(OH)D 浓度与总 CVD 和 IHD 风险降低显著相关，无论其遗传易感性和 VDR 的遗传变异如何。风险降低在血清 25(OH)D 水平约 50 nmol/L 时趋于平稳。这些发现表明，维持足够的维生素 D 状态和避免缺乏可能有助于预防 T2D 患者的 CVD 并发症。
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