The Effect of Vitamin D on Coronary Atherosclerosis: A Propensity Score Matched Case–Control Coronary CTA Study

Abstract

Background: Vitamin D supplementation may be associated with lower cardiovascular (CV) events, but the data are controversial. It remains speculative whether vitamin D supplementation has a direct effect on coronary atherosclerosis. We therefore set out to assess the influence of vitamin D supplementation on the coronary atherosclerosis profile quantified by coronary computed tomography angiography (CTA) in a retrospective case–control cohort study. Methods: 176 patients (age: 62.4 ± 10.4) referred to coronary CTA for clinical indications were included. A total of 88 patients receiving vitamin D supplementation (mean duration 65.3 ± 81 months) were 1:1 propensity score matched with 88 controls for age, gender, smoking, arterial hypertension, positive family history, dyslipidemia, and diabetes. Coronary stenosis severity (CAD-RADSTM), mixed plaque burden (weighted for non-calcified), high-risk-plaque (HRP) features, and plaque density (HU) were quantified by CTA. Serum 25-hydroxyvitamin D (OH)-levels were measured in 138 patients and categorized into four groups (0: <20 ng/mL; 1: 20–40 ng/mL; 2: 40–60 ng/mL; and 3: >60 ng/mL) and compared with CTA. Results: The prevalence of atherosclerosis by CTA was similar in both groups (75.6% versus 74.3%, p = 0.999), >50% coronary stenosis was slightly higher in controls (p = 0.046), but stenosis severity score (CAD-RADS) was not different (p = 0.106). Mixed plaque burden (weighted for non-calcified) was lower in patients receiving vitamin D supplementation (p = 0.002) and high-risk-plaque prevalence was markedly lower (3.8% versus 32%, p < 0.001). CT plaque density (HU) was higher (p < 0.001) in the vitamin D group. Patients with serum vitamin D (OH) levels >60 ng/mL had higher plaque density (p = 0.04), indicating more calcified and less vulnerable plaque. Conclusions: In this retrospective case–control cohort study, vitamin D supplementation was associated with less high-risk plaque, less non-calcified plaque burden, and a higher calcified plaque independent of CV risk factors.

The Role of Exercise-Induced Molecular Processes and Vitamin D in Improving Cardiorespiratory Fitness and Cardiac Rehabilitation in Patients With Heart Failure

“…Specifically, studies conducted in elderly vitamin D deficient individuals have shown that vitamin D supplementation leads to an increase in muscle strength and physical function ( Cannell et al, 2009 ). Moreover, several studies demonstrated the beneficial effects of vitamin D supplementations in terms of prevention in the development of cardiac disease and unfavorable outcomes ( Mirhosseini et al, 2018 ; Acharya et al, 2021 ; Feuchtner et al, 2021 ). However, it is important to mention the inconsistency regarding the results obtained by studies that aimed to assess the positive effects of vitamin D supplementation.…”

Old and Novel Therapeutic Approaches in the Management of Hyperglycemia, an Important Risk Factor for Atherosclerosis

“…A meta-analysis by Seida et al encompassing 35 trials pointed out no beneficial effects of vitamin D supplementation on glucose control, insulin resistance, or T2DM prevention [156]. Moreover, multiple studies have shown that vitamin D can prevent heart disease [157,158], whereas several others have failed in this endeavor [159,160]. Possible explanations for this contradiction may be linked to the limitations in study design, such as duration, insufficient or infrequent doses of vitamin D, and inadequate assessment of subjects in terms of lack of verification of whether subjects reached levels of sufficiency after supplementation.…”

Ultrasound Assessment of Carotid Intima-Media Thickness: Comparison between Diabetes and Nondiabetes Subjects, and Correlation with Serum Vitamin D

“…Diabetes leads to thickening of the carotid intima-medial layer which is considered an early sign of atherosclerosis hereby causing early structural impairment of the carotid vessels [3], on the other hand, there are reports about the efect of vitamin D defciency on Carotid Intima-Media Tickness (CIMT), and many studies including randomized clinical trials have studied the efect of vitamin D supplement on CIMT [4][5][6][7]; however the results for the correlation between vitamin D and atherosclerosis are still controversial [8].…”