Vitamin D sufficiency may reduce MI, all-cause mortality risk in primary prevention
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Treating to a vitamin D level of at least 30 ng/mL is associated with significantly lower risk for myocardial infarction and all-cause mortality among adults with no prior MI history, according to an analysis of Veterans Affairs data.
“Several meta-analyses of epidemiological studies suggested vitamin D deficiency is associated with an increased risk for MI and cardiovascular mortality; however, in several randomized controlled trials, supplementation of vitamin D did not result in lower CV events and mortality,” Rajat S. Barua, MD, PhD, FACC, FSCAI, chief of interventional cardiology and director of cardiovascular research at Kansas City VA Medical Center, and professor of cardiology at University of Kansas School of Medicine, told Healio. “However, these randomized controlled trials included patients who already had optimal baseline vitamin D levels, with most having pretreatment levels above 25 ng/mL to 30 ng/mL. Additionally, posttreatment follow-up of vitamin D for most trials was not assessed to account for effective supplementation, and these trials also had a relatively short-term follow-up. Furthermore, there are limited data available comparing the outcome of MI and mortality with respect to vitamin D levels achieved and maintained after vitamin D supplementation.”
In a nested, case-control study, Acharya and colleagues analyzed data from 20,025 adults with low 25-hydroxyvitamin D levels (less than 20 ng/mL) and without prior history of MI who received care at the VA from 1999 to 2018. Patients had at least two separate measurements of vitamin D levels to confirm level.
Researchers stratified patients by vitamin D treatment status as defined by the Endocrine Society: untreated, with levels of 20 ng/mL or lower (group A; n = 11,119); treated, with vitamin D levels ranging from 21 ng/mL to 29 ng/mL (group B; n = 5,623); and treated, with vitamin D levels of at least 30 ng/mL (group C; n = 3,277). The risk for MI and all-cause mortality were compared utilizing propensity score-weighted Cox proportional hazard models.
Researchers found risk for MI was significantly lower in the treated, vitamin D-sufficient group C compared with groups B and A, with HRs of 0.65 (95% CI, 0.49-0.85) and 0.73 (95% CI, 0.55-0.96), respectively.
There was no difference in MI risk between groups B and A.
“Based on our study, in vitamin D-deficient patients, repeated measurement and aiming for appropriate target levels of 25-hydroxyvitamin D levels are important determinants of outcomes in these patients,” Barua told Healio. “Our study highlights that in this population, a target 25-hydroxyvitamin D level of at least 20 ng/mL would be sufficient for all-cause mortality, but to reduce the risk for MI in these patients, the 25-hydroxyvitamin D levels needs to be at least 30 ng/mL.”
For more information:
Rajat S. Barua, MD, PhD, FACC, FSCAI, can be reached at rajat.barua@va.gov.
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