Vitamin D as a risk factor for premature atherosclerosis in patients with type 2 diabetes

Abstract

Background: Several cardiovascular risk factors have been recognized in patients with diabetes and vitamin D deficiency is emerging as a new risk. The aim of this study was to determine the effect of vitamin D deficiency on the incidence of premature atherosclerosis in patients with type 2 diabetes. Methods: A total of 78 patients with type 2 diabetes were subjected to history taking, physical examination, fasting glucose level, homeostasis model assessment of insulin resistance, lipid profile, 25(OH) vitamin D measurement, and carotid Doppler. Results: Patients with normal carotid intima-media thickness (CIMT) had sufficient vitamin D. Of those with increased CIMT 23.1% had insufficient vitamin D while 76.9% had sufficient vitamin D (six patients had plaques, one of them had vitamin D insufficiency, and the other five patients had sufficient vitamin D). There was a statistically significant difference in the serum level of vitamin D between patients with increased CIMT, and those with normal intima, with a decreased level in the first group. There was a significant negative correlation between vitamin D and fasting blood glucose. There was a statistically significant correlation in left CIMT between the vitamin D sufficiency group and the vitamin D insufficiency group, with higher values in the second group. There was no statistically significant difference in serum cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol in patients with increased CIMT and those with normal intima. Conclusions: Decreased vitamin D levels in patients with diabetes lead to increased CIMT. The absence of a statistically significance difference in lipid profile between increased and normal CIMT groups raises the possibility of underlying causes for atherosclerosis in patients with diabetes other than dyslipidemia.

Serum Vitamin D Level and Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis of Observational Studies and Randomized Control Trials

“…Main summary of the characteristics of the included studies are described in ▶ Tables 1-3. A total of 22 studies published from 2006 to 2017 covering a total of 7332 human participants, from studies in different countries (Korea [15], Italy [16][17][18][19][20], Sweden [21], China [22][23][24][25][26][27], USA [28,29], Egypt [30], Scandinavian [31], Turkey [1], Iran [7,32], Bulgaria [33], and UK [34]) with age ranging from 18 to 75 years, were identified in this meta-analysis. Most of the participants were women.…”

“…There were 17 studies reported the mean serum level of vitamin D and correlation coefficients between association serum vitamin D level and CIMT. Participants were outpatients who underwent eco-Doppler examination of the extra cranial carotid tract [17], pa-tients with mild primary hyperparathyroidism (PHPT) without any known cardiovascular risk factors [21], patients with type 2 diabetes [16,23,27,30], adults with hypertension [29], high-risk cardiac patients [25], patients with obstructive sleep apnea syndrome (OSA) [31], subjects with high cardiovascular risk [34], middle-aged and elderly men [24], postmenopausal women [22,26], post-menopausal women with Sjogren's syndrome [20], adults with growth hormone deficiency [33], subjects with pre-diabetes [19], patients with Behcet's disease [18] and patients with subclinical carotid atherosclerosis [34]. Forest plot displaying the effect of vitamin D supplementation on CIMT is shown in ▶ Fig.…”

“…When combining males and females (eight studies) [16-19, 27, 29-31], pooled data were (Fisher's z = -0.71, 95 % CI (-0.801 to -0.63), p = < 0.001), I 2 = 97 %, p = < 0.001). Four studies [19,29,30,33] reporting correlation between Vitamin D and CIMT in people under 50 years and pooled data were Fisher's z = -0.47, 95 % CI (-0.61 to -0.34), p = < 0.001), I 2 = 82.2 %. p = < 0.001).…”

The effects of vitamin D, K and calcium co-supplementation on carotid intima-media thickness and metabolic status in overweight type 2 diabetic patients with CHD

“…Decreased vitamin D levels were associated with increased CIMT ( 6 ) , insulin resistance and inflammation ( 7 ) . Furthermore, Braam et al ( 8 ) found that long-term supplementation with vitamins K 1 (1 mg) and D (8 µg) had beneficial effects on elastic properties of the carotid artery in postmenopausal women, but it did not influence CIMT.…”

Vitamin D Status and Cardiovascular Risk Factors in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in a Tertiary-Level Hospital in Antananarivo, Madagascar

“… 40 Hamdy Al-Said et al also found that hypovitaminosis in diabetic patients may be a risk factor for premature atherosclerosis assessed from the increase in intima-media thickness of the carotid artery in patients with T2DM. 41 An Italian study showed that hypovitaminosis D was independently associated with an increased prevalence and severity of coronary artery disease. 42 The roles of hypovitaminosis D in increasing the risk of cardiovascular diseases could be direct or indirect.…”