Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia; Faculty of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia.
Clin Nutr ESPEN. 2024 Aug;62:66-75. doi: 10.1016/j.clnesp.2024.04.018. Epub 2024 May 15.
The emerging role of vitamin D has drawn the attention of researchers around the world, including its involvement in cardiovascular complications among individuals with diabetes.
This study aimed to obtain comprehensive evidence on the association between serum vitamin D level and the risk of cardiovascular disease among patients with diabetes.
Systematic search was performed on July 1st, 2023, to identify and screen published literature reporting the association between vitamin D and cardiovascular disease among diabetic patients in six databases. Each eligible study was appraised for its quality using modified Newcastle Ottawa Scale for cross-sectional and cohort studies. Meta-analysis was performed using Dersimonian-Laird random effect model or fix-effect model. The heterogeneity and publication bias were judged based on percentage of I and the symmetry of Begg's funnel plot, respectively.
As many as 22 studies were found eligible for the systematic review. A meta-analysis from 13 studies comprising of 3850 and 1797 (control and exposure groups, respectively) revealed that serum vitamin D level was significantly lower in patients with diabetes and cardiovascular diseases (Z = 4.89; p-total<0.001; SMD = 0.68 [95%CI: 0.41-0.95]), yet the heterogeneity was high. Following the adjustment of removing the potential outliers, the same results were still observed (Z = 6.19; p-total<0.001; SMD = 0.35 [95%CI: 0.24-0.46]). Though decreased, high heterogeneity could not be resolved, resulting in moderate level of this evidence. Another pooled analysis of 7 studies with 4211 patients in control group and 2381 patients in exposure group revealed that lower level of serum vitamin D is a risk factor for cardiovascular disease incidence among diabetic patients (Z = 4.89; p-total<0.001; OR: 1.76 [95%CI: 1.4-2.2]).
Serum vitamin D level status is a risk factor for developing cardiovascular diseases among diabetic patients, hence should be carefully monitored and maintained.
CRD42023437698.
维生素 D 的新作用引起了全世界研究人员的关注，包括其在糖尿病患者心血管并发症中的作用。
本研究旨在获得关于血清维生素 D 水平与糖尿病患者心血管疾病风险之间关联的综合证据。
于 2023 年 7 月 1 日在六个数据库中进行系统检索，以识别和筛选报告糖尿病患者维生素 D 与心血管疾病之间关联的已发表文献。使用改良的纽卡斯尔-渥太华量表对每个合格研究进行质量评估，用于横断面和队列研究。使用 Dersimonian-Laird 随机效应模型或固定效应模型进行荟萃分析。根据百分比 I 和 Begg 漏斗图的对称性分别判断异质性和发表偏倚。
共发现 22 项研究符合系统评价的条件。对包括 3850 名（对照组和暴露组）和 1797 名患者的 13 项研究进行荟萃分析显示，糖尿病合并心血管疾病患者的血清维生素 D 水平显著较低（Z=4.89；p 总<0.001；SMD=0.68 [95%CI：0.41-0.95]），但异质性较高。在排除潜在异常值后进行调整，仍观察到相同结果（Z=6.19；p 总<0.001；SMD=0.35 [95%CI：0.24-0.46]）。尽管有所降低，但仍无法解决高度异质性，导致该证据处于中等水平。对包括 4211 名对照组患者和 2381 名暴露组患者的 7 项研究的另一个汇总分析显示，血清维生素 D 水平较低是糖尿病患者心血管疾病发生率的危险因素（Z=4.89；p 总<0.001；OR：1.76 [95%CI：1.4-2.2]）。
血清维生素 D 水平状况是糖尿病患者发生心血管疾病的危险因素，因此应密切监测和维持。
PROSPERO 注册号：CRD42023437698。
