Rainer Katharine W, Earle William, Michos Erin D, Miller Edgar R, Wanigatunga Amal A, Rebuck Heather, Christensen Robert, Schrack Jennifer A, Mitchell Christine M, Kalyani Rita R, Appel Lawrence J, Juraschek Stephen P
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Prev Cardiol. 2024 Sep 26;20:100871. doi: 10.1016/j.ajpc.2024.100871. eCollection 2024 Dec.
In observational studies, older adults with low serum vitamin D levels are at higher risk of cardiovascular disease (CVD), but randomized trials have failed to demonstrate reduction in CVD risk from vitamin D supplementation, possibly because the doses of vitamin D supplements tested were too low. Our objective was to determine if higher doses of vitamin D supplementation reduce high-sensitivity cardiac troponin (hs-cTnI) and N-terminal pro-b-type natriuretic peptide (NT-proBNP), markers of subclinical CVD.
The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 supplementation (200, 1000, 2000, 4000 IU/day) on fall risk among older adults with low serum 25-hydroxyvitamin D concentrations (10-29 ng/mL). Hs-cTnI and NT-proBNP levels were measured at baseline, 3-, 12-, and 24-month follow-up visits. For this ancillary study, we used data from the original trial and compared participants by treatment group: low-dose (200 IU/day) or high-dose (1000+ IU/day). The effects of vitamin D dose on biomarkers were assessed via mixed effects tobit models.
Among 688 participants (mean age of 76.5) hs-cTnI increased in both the low- and high-dose groups by 5.2 % and 7.0 %, respectively; likewise, NT-proBNP increased by 11.3 % and 9.3 %, respectively. Compared to the low-dose, high-dose vitamin D supplementation did not affect hs-cTnI (1.6 %-difference; 95 % CI: -5.3, 8.9) or NT-proBNP (-1.8 %-difference; 95 % CI: -9.3, 6.3).
Compared to low-dose vitamin D supplementation, doses ≥1,000 IU/ day did not affect markers of subclinical CVD in older adults with low serum vitamin D levels.
在观察性研究中，血清维生素D水平低的老年人患心血管疾病（CVD）的风险较高，但随机试验未能证明补充维生素D可降低CVD风险，这可能是因为所测试的维生素D补充剂剂量过低。我们的目的是确定更高剂量的维生素D补充剂是否能降低高敏心肌肌钙蛋白（hs-cTnI）和N末端B型利钠肽原（NT-proBNP），这两种都是亚临床CVD的标志物。
了解维生素D对降低您跌倒风险的研究（STURDY）是一项双盲、随机、适应性反应试验，测试了4种剂量的维生素D3补充剂（200、1000、2000、4000 IU/天）对血清25-羟维生素D浓度低（10-29 ng/mL）的老年人跌倒风险的影响。在基线、3个月、12个月和24个月的随访中测量hs-cTnI和NT-proBNP水平。在这项辅助研究中，我们使用了原始试验的数据，并按治疗组对参与者进行了比较：低剂量（200 IU/天）或高剂量（1000+IU/天）。通过混合效应 Tobit 模型评估维生素D剂量对生物标志物的影响。
在688名参与者（平均年龄76.5岁）中，低剂量组和高剂量组的hs-cTnI分别增加了5.2%和7.0%；同样，NT-proBNP分别增加了11.3%和9.3%。与低剂量相比，高剂量补充维生素D对hs-cTnI（差异1.6%；95%CI：-5.3，8.9）或NT-proBNP（差异-1.8%；95%CI：-9.3，6.3）没有影响。
与低剂量补充维生素D相比，每天剂量≥1000 IU对血清维生素D水平低的老年人的亚临床CVD标志物没有影响。
