25-Hydroxyvitamin D Levels Inversely Associate with Risk for Developing Coronary Artery Calcification

Abstract

Vitamin D deficiency associates with increased risk for cardiovascular events and mortality, but the mechanism driving this association is unknown. Here, we tested whether circulating 25-hydroxyvitamin D concentration associates with coronary artery calcification (CAC), a measure of coronary atherosclerosis, in the Multi-Ethnic Study of Atherosclerosis. We included 1370 participants: 394 with and 976 without chronic kidney disease (estimated GFR Ͻ60 ml/min per 1.73 m 2 ). At baseline, CAC was prevalent among 723 (53%) participants. Among participants free of CAC at baseline, 135 (21%) developed incident CAC during 3 yr of follow-up. Lower 25-hydroxyvitamin D concentration did not associate with prevalent CAC but did associate with increased risk for developing incident CAC, adjusting for age, gender, race/ethnicity, site, season, physical activity, smoking, body mass index, and kidney function. Further adjustment for BP, diabetes, C-reactive protein, and lipids did not alter this finding. The association of 25-hydroxyvitamin D with incident CAC seemed to be stronger among participants with lower estimated GFR. Circulating 1,25-dihydroxyvitamin D concentrations among participants with chronic kidney disease did not significantly associate with prevalent or incident CAC in adjusted models. In conclusion, lower 25-hydroxyvitamin D concentrations associate with increased risk for incident CAC. Accelerated development of atherosclerosis may underlie, in part, the increased cardiovascular risk associated with vitamin D deficiency.

Decreased Conversion of 25-hydroxyvitamin D3 to 24,25-dihydroxyvitamin D3 Following Cholecalciferol Therapy in Patients with CKD

“…Vitamin D insufficiency is prevalent in patients with CKD and is believed to contribute to an abundance of adverse clinical outcomes in this group (21)(22)(23)(24)(25). Although the cause of low 25(OH)D and 1a,25(OH) 2 D concentrations in CKD is likely multifactorial, it is postulated that FGF23 contributes to this clinical entity through its stimulation of renal 24-hydroxlase activity (11).…”

“…Analyte detection was achieved using positive atmospheric pressure chemical ionization and selected reaction monitoring. Standard curve ranges were 0.010-0.500 ng/ml (1a, 25 …”

Solar radiation and human health

“…The hazard ratios for serum 25(OH)D levels compared with 107 nmol l [444], and risk of developing coronary artery calcification is inversely correlated with serum 25(OH)D levels [445], but other vitamin D-mediated mechanisms could also be involved [396].…”

Low Calcidiol Levels and Coronary Artery Calcification

“…In this issue of JASN, de Boer et al 19 report an analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) suggesting that low calcidiol levels associate with subsequent development of CAC. In this well-analyzed study of 647 participants (mean age 64.0 yr; 35% white, 31% black, 13% Chinese, and 21% Hispanic; 21% with estimated GFR Ͻ60 ml/min per 1.73 m 2 ; 29% with calcidiol levels Ͻ15 ng/ml; all free from CAC at baseline), 135 participants developed incident CAC during 3 yr of follow-up.…”

“…An additional strength is the temporality of the association: Participants with low calcidiol levels at baseline subsequently developed CAC. Whereas most previous studies linking vitamin D and vascular calcification used a cross-sectional design, the study by de Boer et al 19 is unique because of its prospective data. A few potential limitations of the study include that, in secondary analyses, calcidiol levels did not associate with the progression of plaque or severity of plaque.…”