Chen Xue, Xu Jiajing, Wan Zhenzhen, Geng Tingting, Zhu Kai, Li Rui, Lu Qi, Lin Xiaoyu, Liu Sen, Ou Yunjing, Yang Kun, An Pan, Manson JoAnn E, Liu Gang
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 Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Am J Clin Nutr. 2024 Sep;120(3):491-498. doi: 10.1016/j.ajcnut.2024.07.019. Epub 2024 Jul 23.
Evidence is limited and inconsistent regarding vitamin D and heart failure (HF) risk in people with type 2 diabetes (T2D), among whom vitamin D insufficiency or deficiency is common.
This study aimed to investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] with HF risk among individuals with T2D, in observational and Mendelian randomization (MR) frameworks.
Observational analyses were performed among 15,226 T2D participants aged 40-72 y from the UK Biobank. HF incidence was ascertained through electronic health records. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between serum 25(OH)D and HF risk among people with T2D. MR analyses were conducted among 11,260 unrelated participants with T2D. A weighted genetic risk score for genetically predicted 25(OH)D concentration was instrumented using 62 confirmed genome-wide variants.
The mean ± standard deviation of serum 25(OH)D was 43.4 ± 20.4 nmol/L. During a median follow-up of 11.3 y, 836 incident HF events occurred. Serum 25(OH)D was nonlinearly and inversely associated with HF and the decreasing risk tended to plateau at around 50 nmol/L. Comparing those with 25(OH)D <25 nmol/L, the multivariable-adjusted HR (95% CI) was 0.67 (0.54, 0.83) for participants with 25(OH)D of 50.0-74.9 nmol/L and was 0.71 (0.52, 0.98) for 25(OH)D >75 nmol/L. In MR analysis, each 7% increment in genetically predicted 25(OH)D was associated with 36% lower risk of HF among people with T2D (HR: 0.64, 95% CI: 0.41, 0.99).
Higher serum 25(OH)D was associated with lower HF risk among individuals with T2D and the MR analysis suggested a potential causal relationship. These findings indicate a role of maintaining adequate vitamin D status in the prevention of HF among individuals with T2D.
关于2型糖尿病（T2D）患者中维生素D与心力衰竭（HF）风险的证据有限且不一致，其中维生素D不足或缺乏很常见。
本研究旨在在观察性和孟德尔随机化（MR）框架下，调查血清25-羟基维生素D [25(OH)D] 与T2D患者HF风险之间的关联。
对来自英国生物银行的15226名年龄在40-72岁的T2D参与者进行观察性分析。通过电子健康记录确定HF发病率。采用Cox比例风险回归模型估计T2D患者血清25(OH)D与HF风险之间关联的风险比（HRs）和95%置信区间（CIs）。对11260名无亲属关系的T2D参与者进行MR分析。使用62个已确认的全基因组变异构建遗传预测的25(OH)D浓度的加权遗传风险评分。
血清25(OH)D的平均值±标准差为43.4±20.4 nmol/L。在中位随访11.3年期间，发生了836例HF事件。血清25(OH)D与HF呈非线性负相关，风险降低趋势在约50 nmol/L时趋于平稳。与25(OH)D<25 nmol/L的人相比，25(OH)D为50.0-74.9 nmol/L的参与者的多变量调整HR（95%CI）为0.67（0.54，0.83），25(OH)D>75 nmol/L的参与者为0.71（0.52，0.98）。在MR分析中，遗传预测的25(OH)D每增加7%，T2D患者发生HF的风险降低36%（HR：0.64，95%CI：0.41，0.99）。
T2D患者血清25(OH)D水平较高与HF风险较低相关，MR分析提示存在潜在因果关系。这些发现表明维持充足的维生素D状态在预防T2D患者HF方面发挥作用。
