Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in a Large Cohort: Results From t he UK Biobank
Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in a Large Cohort: Results From t he UK Biobank
复制标题
DOI：
10.1210/clinem/dgaa432
复制
发表时间：
2020-10-01
影响因子：
5.8
通讯作者：
Hang, Dong
中科院分区：
文献类型：
--
作者：
Fan, Xikang;Wang, Jiayu;Hang, Dong
背景：虽然观察性研究报告了维生素 D 状态与死亡率之间存在负相关，但精确的关联形状和最佳维生素 D 状态仍未确定。目的：调查维生素 D 状态与全因和特定原因死亡风险之间的关联，并估计最佳血清 25-羟基维生素 D [25(OH)D] 浓度。设计：前瞻性队列研究。地点：英国生物银行。参与者：365 530 名接受过血清检查的参与者基线时（2006-2010 年）进行 25(OH)D 测量，无心血管疾病 (CVD)、癌症或糖尿病史。主要结局指标：全因死亡率和特定原因死亡率。结果：在中位随访 8.9 年（四分位距：8.3-9.5）期间，发生 10 175 例死亡，其中 1841 例 (18.1%) 因 CVD 死亡，5737 例死亡(56.4%) 因癌症。多变量分析揭示了非线性负相关关系，全因死亡和 CVD 死亡的死亡风险在 25(OH)D 浓度为 60 nmol/L 时趋于稳定，癌症死亡风险在 25(OH)D 浓度为 45 nmol/L 时趋于稳定。与 25(OH)D 浓度低于临界值的参与者相比，浓度较高的参与者全因死亡风险降低 17%（风险比 [HR]：0.83，95% 置信区间 [CI]：0.79-0.86），CVD 死亡风险降低 23%（HR：0.77，95% CI：0.68-0.86），心血管疾病死亡风险降低 11%癌症死亡率（HR：0.89，95% CI：0.84-0.95）。结论：较高的 25(OH)D 浓度与较低的全因死亡率、CVD 和癌症死亡率呈非线性相关。 45至60 nmol/L的阈值可能代表降低过早死亡总体风险的干预目标，这需要大型临床试验的进一步证实。
Context: Although an inverse association between vitamin D status and mortality has been reported in observational studies, the precise association shape and optimal vitamin D status remain undetermined.Objective: To investigate the association between vitamin D status and risk of all-cause and cause-specific mortality and estimate optimal serum 25-hydroxyvitamin D [25(OH)D] concentrations.Design: Prospective cohort study.Setting: UK Biobank.Participants: 365 530 participants who had serum 25(OH)D measurements and no history of cardiovascular disease (CVD), cancer, or diabetes at baseline (2006-2010).Main outcome measures: All-cause and cause-specific mortality.Results: During a median follow-up of 8.9 (interquartile range: 8.3-9.5) years, 10 175 deaths occurred, including 1841 (18.1%) due to CVD and 5737 (56.4%) due to cancer. The multivariate analyses revealed nonlinear inverse associations, with a decrease in mortality risk appearing to level off at 60 nmol/L of 25(OH)D for all-cause and CVD deaths and at 45 nmol/L for cancer deaths. Compared to participants with 25(OH)D concentrations below the cutoffs, those with higher concentrations had a 17% lower risk for all-cause mortality (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.79-0.86), 23% lower risk for CVD mortality (HR: 0.77, 95% CI: 0.68-0.86), and 11% lower risk for cancer mortality (HR: 0.89, 95% CI: 0.84-0.95).Conclusions: Higher 25(OH)D concentrations are nonlinearly associated with lower risk of all-cause, CVD, and cancer mortality. The thresholds of 45 to 60 nmol/L might represent an intervention target to reduce the overall risk of premature death, which needs further confirmation in large clinical trials.