Volume 4, Issue 3, September 2020, Page: 119-126
Association of Major Cardiovascular Risk Factors and the Severity of Coronary Artery Disease with Vitamin D Level
Ahmed Hussein, Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt
Sherif Abdelaziz Sayed, Department of Clinical Pathology, Faculty of Medicine, Sohag University, Sohag, Egypt
Mohammad Shafiq Awad, Department of Cardiology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
Received: Jul. 25, 2020;       Accepted: Aug. 5, 2020;       Published: Aug. 13, 2020
DOI: 10.11648/j.ccr.20200403.17      View  117      Downloads  61
Abstract
Objectives: We aimed to investigate the association of major cardiovascular risk factors and the severity of coronary artery disease (CAD) with vitamin D level. Background: Numerous efforts have been made to reduce cardiovascular morbidity and mortality, especially in acute coronary syndrome (ACS). However, results are still not optimal. Much consideration is set on the revelation of new, conceivably modifiable cardiovascular risk factors. Vitamin D deficiency is proposed to be one such factor, and it might be related to an increased risk of cardiovascular diseases. Methods: We conducted a cross-section study on 475 patients undergoing elective coronary angiography, the participants were subjected to assessment of vitamin D level and major cardiovascular risk factors. The severity of CAD was assessed using the gensini score. Results: There were 352 (74.11%) patients, had a significant CAD. We found that vitamin D level had a significant negative correlation with the gensini score while diabetes and dyslipidemia had a significant positive correlation. The multivariate regression analysis showed that, vitamin D deficiency, diabetes, dyslipidemia, higher BMI, and ACS (p-value <0.05), were statistically significant predictors of a significant CAD. There were 184 (38.74%) patients, had vitamin D deficiency. Also, we found that diabetes and dyslipidemia had a significant negative correlation with vitamin D level. The multivariate regression analysis showed that diabetes and dyslipidemia were statistically significantly associated with low vitamin D levels (p-value 0.005 and 0.024 respectively). Conclusions: Vitamin D deficiency, diabetes, dyslipidemia, higher BMI, and ACS were statistically significant associated with severe CAD. Also, diabetes and dyslipidemia were statistically significant associated with vitamin D deficiency.
Keywords
CAD, Cardiovascular Risk Factors, Gensini Score, Vitamin D Level
To cite this article
Ahmed Hussein, Sherif Abdelaziz Sayed, Mohammad Shafiq Awad, Association of Major Cardiovascular Risk Factors and the Severity of Coronary Artery Disease with Vitamin D Level, Cardiology and Cardiovascular Research. Vol. 4, No. 3, 2020, pp. 119-126. doi: 10.11648/j.ccr.20200403.17
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
De Luca G., Smit JJ, Ernst N, et al. Impact of adjunctive tirofiban administration on myocardial perfusion and mortality in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Thromb. Haemost. 2005; 93: pp. 820-823.
[2]
De Luca G., Verdoia M., and Suryapranata H. Benefits from intracoronary as compared to intravenous abciximab administration for STEMI patients undergoing primary angioplasty: a meta-analysis of 8 randomized trials. Atherosclerosis 2012; 222: pp. 426-433.
[3]
De Luca G., Navarese E. P., and Suryapranata H. A meta-analytic overview of thrombectomy during primary angioplasty. Int. J. Cardiol. 2013; 166: pp. 606-612.
[4]
De Luca G, Dirksen MT, Spaulding C, et al. Impact of hypertension on clinical outcome in STEMI patients undergoing primary angioplasty with BMS or DES: insights from the DESERT cooperation. Int J Cardiol. 2014; 175 (1): 50-54.
[5]
Zittermann A, Schleithoff SS, Koerfer R. Putting cardiovascular disease and vitamin D insufficiency into perspective. Br J Nutr. 2005; 94: 483–92.
[6]
Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357: 266–81.
[7]
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96: 1911–30.
[8]
Querfeld U.: Vitamin D and inflammation. Pediatr. Nephrol. 2013; 28: pp. 605-610.
[9]
Buitrago C. G., Arango N. S., and Boland R. L.: 1α, 25 (OH) 2D3-dependent modulation of Akt in proliferating and differentiating C2C12 skeletal muscle cells. J. Cell. Biochem. 2012; 113: pp. 1170-1181.
[10]
Li YC, Kong J, Wei M, et al. 1,25-Dihydroxyvitamin D (3) is a negative endocrine regulator of the emode-angiotensin system. J Clin Invest. 2002; 110: 229–38.
[11]
Kassi E, Adamopoulos C, Basdra EK, et al. Role of vitamin D in atherosclerosis. Circulation. 2013; 128: 2517–31.
[12]
Shankar A., Sabanayagam C., and Kalidindi S.: Serum 25-hydroxyvitamin d levels and prediabetes among subjects free of diabetes. Diabetes Care 2011; 34: pp. 1114-1119.
[13]
Gagnon C, Lu ZX, Magliano DJ, et al. Low serum 25-hydroxyvitamin D is associated with increased risk of the development of the metabolic syndrome at five years: results from a national, population-based prospective study. J Clin Endocrinol Metab. 2012; 97: 1953–61.
[14]
Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007; 92: 2017–29.
[15]
Lamendola CA, Ariel D, Feldman D, Reaven GM. Relations between obesity, insulin resistance, and 25-hydroxyvitamin D. Am J Clin Nutr. 2012; 95: 1055–105.
[16]
Dziedzic EA, Przychodzeń S, Dąbrowski M. The effects of vitamin D on severity of coronary artery atherosclerosis and lipid profile of cardiac patients. Arch Med Sci. 2016; 12: 1199–206.
[17]
Josko D. Updates in immunoassays: introduction. Clin Lab Sci. 2012; 25 (3): 170-172.
[18]
Gensini, G. G. (1983) A More Meaningful Scoring System for Determining the Severity of Coronary Heart Disease. American Journal of Cardiology, 51, 606.
[19]
Standards of Medical Care in Diabetes. Diabetes Care 2015; 38 (Suppl 1): S3.
[20]
Efrain Reisin, Raymond C. Harris, Mahboob Rahman. Commentary on the 2014 BP Guidelines from the Panel Appointed to the Eighth Joint National Committee (JNC 8). J Am Soc Nephrol. 2014 Nov; 25 (11): 2419–2424.
[21]
American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33: pp. S62-S69.
[22]
Dziedzic EA, Gąsior JS, Pawłowski M, et al. Association of Vitamin D Deficiency and Degree of Coronary Artery Disease in Cardiac Patients with Type 2 Diabetes. J Diabetes Res. 2017; 2017: 3929075.
[23]
Dziedzic EA, Gąsior JS, Pawłowski M, et al. Vitamin D level is associated with severity of coronary artery atherosclerosis and incidence of acute coronary syndromes in non-diabetic cardiac patients. Arch Med Sci. 2019; 15 (2): 359-368.
[24]
Verdoia M, Schaffer A, Sartori C, et al. Vitamin D deficiency is independently associated with the extent of coronary artery disease. Eur J Clin Invest. 2014; 44 (7): 634-642.
[25]
Schneider AL, Lutsey PL, Selvin E, et al. Vitamin D, vitamin D binding protein gene polymorphisms, race and risk of incident stroke: the Atherosclerosis Risk in Communities (ARIC) study. Eur J Neurol. 2015; 22: 1220–7.
[26]
Michos ED, Misialek JR, Selvin E, et al. 25-hydroxyvitamin D levels, vitamin D binding protein gene polymorphisms and incident coronary heart disease among whites and blacks: the ARIC study. Atherosclerosis. 2015; 241: 12–7.
[27]
Goleniewska BM, Kacprzak M, Zielinska M. Vitamin D level and extent of coronary stenotic lesions in patients with first acute myocardial infarction. Cardiol J 2014; 21: 18–23.
[28]
Shor R, Tirosh A, Shemesh L, et al. 25 hydroxyvitamin D levels in patients undergoing coronary artery catheterization. Eur J Intern Med. 2012; 23: 470–3.
[29]
Syal SK, Kapoor A, Bhatia E, et al. Vitamin D deficiency, coronary artery disease, and endothelial dysfunction: observations from a coronary angiographic study in Indian patients. J Invasive Cardiol. 2012; 24: 385–9.
[30]
Gondim F., Caribé A., Vasconcelos K. F., et al. Vitamin D deficiency is associated with severity of acute coronary syndrome in patients with type 2 diabetes and high rates of sun exposure. Clinical Medicine Insights. Endocrinology and Diabetes. 2016; 9: 37–41.
[31]
Shanker J, Maitra A, Arvind P, et al. Role of vitamin D levels and vitamin D receptor polymorphisms in relation to coronary artery disease: the Indian atherosclerosis research study. Coron Artery Dis 2011; 22: 324–32.
[32]
Verdoia M, Schaffer A, Barbieri L, et al. Impact of gender difference on vitamin D status and its relationship with the extent of coronary artery disease. Nutr Metab Cardiovasc Dis. 2015; 25 (5): 464-470.
[33]
Jiang X, Peng M, Chen S, et al. Vitamin D deficiency is associated with dyslipidemia: a cross-sectional study in 3788 subjects. Curr Med Res Opin. 2019; 35 (6): 1059-1063.
[34]
Jorde R, Figenschau Y, Hutchinson M, et al. High serum 25-hydroxyvitamin D concentrations are associated with a favorable serum lipid profile. Eur J Clin Nutr. 2010; 64 (12): 1457-1464.
[35]
Chaudhuri JR, Mridula KR, Anamika A, et al. Deficiency of 25-hydroxyvitamin d and dyslipidemia in Indian subjects. J Lipids. 2013; 2013: 623420.
[36]
Ge H, Sun H, Wang T, et al. The association between serum 25-hydroxyvitamin D3 concentration and serum lipids in the rural population of China. Lipids Health Dis. 2017; 16 (1): 215.
[37]
Alhewishel M A, Bahgat M, Al Huwaiyshil A, et al. 25 (OH) D Serum Level in Non-Diabetic and Type II Diabetic Patients: A Cross-Sectional Study. Cureus 2020; 12 (6): e8910.
[38]
Dalgård C, Petersen MS, Weihe P, et al. Vitamin D status in relation to glucose metabolism and type 2 diabetes in septuagenarians. Diabetes Care. 2011; 34 (6): 1284-1288. doi: 10.2337/dc10-2084.
[39]
Sugden JA, Davies JI, Witham MD, et al. Vitamin D improves endothelial function in patients with type 2 diabetes mellitus and low vitamin D levels. Diabet Med 2008; 25: 320–5.
[40]
Witham MD, Dove FJ, Sugden JA, et al. The effect of vitamin D replacement on markers of vascular health in stroke patients – a randomised controlled trial. Nutr Metab Cardiovasc Dis 2012; 22: 864–70.
[41]
Wu C., Qiu S., Zhu X., et al. Vitamin D supplementation and glycemic control in type 2 diabetes patients: a systematic review and meta-analysis. Metabolism. 2017; 73: 67–76.
[42]
Pittas A. G., Dawson-Hughes B., Sheehan P. R., et al. Rationale and design of the vitamin D and type 2 diabetes (D2d) study: a diabetes prevention trial. Diabetes Care. 2014; 37 (12): 3227–3234.
[43]
Mitri J., Dawson-Hughes B., Hu F., Pittas A. Effects of vitamin D and calcium supplementation on pancreatic β cell function, insulin sensitivity, and glycemia in adults at high risk of diabetes: the Calcium and Vitamin D for Diabetes Mellitus (CaDDM) randomized controlled trial. American Journal of Clinical Nutrition. 2011; 94 (2): 486–494.
[44]
Pittas A. G., Harris S. S., Stark P. C., Dawson-Hughes B. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults. Diabetes Care. 2007; 30 (4): 980–986.
[45]
Sokol SI, Srinivas V, Crandall JP, et al. The effects of vitamin D repletion on endothelial function and inflammation in patients with coronary artery disease. Vasc Med 2012; 17: 394–404.
[46]
Elamin MB, Abu Elnour NO, Elamin KB, et al. Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96: 1931–42.
Browse journals by subject