Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography
Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography
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DOI：
10.1210/jc.2008-0784
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发表时间：
2008-10-01
影响因子：
5.8
通讯作者：
Dobnig, Harald
中科院分区：
文献类型：
--
作者：
Pilz, Stefan;Maerz, Winfried;Dobnig, Harald
内容：维生素D已被证明影响心肌收缩力和心肌钙稳态。目的：我们旨在阐明维生素D不足是否与心力衰竭和心源性猝死（SCD）有关。设计、设置和参与者：我们测量了3299例在基线时常规接受冠状动脉造影的高加索患者的25-羟基维生素D [25（OH）D]水平（1997-2000）.主要结果测量：主要结果是25（OH）D水平与心力衰竭测量的横截面相关性，以及根据维生素D状态，心力衰竭死亡和SCD死亡的考克斯比例风险比。25（OH）D与N-末端pro-B-与高纽约心脏协会分级和左心室功能受损呈负相关。在7.7年的中位随访时间内，116例患者死于心力衰竭，188例死于SCD。校正心血管危险因素后，与严重维生素D缺乏[25（OH）D = 75 nmol/L]的患者相比，心力衰竭和SCD死亡的风险比（95%置信区间）分别为2.84（1.20-6.74）和5.05（2.13-11.97）。在所有的统计分析中，我们得到了类似的结果与25（OH）D和1，25-二羟维生素D的结论：低水平的25（OH）D和1，25-二羟维生素D与普遍的心肌功能障碍，死亡，由于心力衰竭，SCD。干预性试验是必要的，以阐明是否维生素D补充剂是有用的治疗和/或预防心肌疾病。
Context: Vitamin D has been shown to influence cardiac contractility and myocardial calcium homeostasis.Objectives: We aimed to elucidate whether insufficient vitamin D status is associated with heart failure and sudden cardiac death (SCD).Design, Setting, and Participants: We measured 25-hydroxyvitamin D [25(OH)D] levels in 3299 Caucasian patients who were routinely referred to coronary angiography at baseline (1997-2000).Main Outcome Measures: The main outcome was cross-sectional associations of 25(OH)D levels with measures of heart failure and Cox proportional hazard ratios for deaths due to heart failure and for SCD according to vitamin D status.Results: 25(OH)D was negatively correlated with N-terminal pro-B-type natriuretic peptide and was inversely associated with higher New York Heart Association classes and impaired left ventricular function. During a median follow-up time of 7.7 yr, 116 patients died due to heart failure and 188 due to SCD. After adjustment for cardiovascular risk factors, the hazard ratios (with 95% confidence intervals) for death due to heart failure and for SCD were 2.84 (1.20-6.74) and 5.05 (2.13-11.97), respectively, when comparing patients with severe vitamin D deficiency [25(OH)D = 75 nmol/liter]. In all statistical analyses, we obtained similar results with 25(OH)D and with 1,25-dihydroxyvitamin D.Conclusions: Low levels of 25(OH)D and 1,25-dihydroxyvitamin D are associated with prevalent myocardial dysfunction, deaths due to heart failure, and SCD. Interventional trials are warranted to elucidate whether vitamin D supplementation is useful for treatment and/or prevention of myocardial diseases.