Vitamin D deficiency and electrocardiographic subclinical myocardial injury: Results from National Health and Nutrition Examination Survey‐III

Abstract

Background Association of cardiovascular disease (CVD) with nontraditional risk factors such as vitamin D deficiency has been examined previously. An investigation of the association of vitamin D with subclinical myocardial injury (SC‐MI) based on an electrocardiographic score is a simple, cost‐effective and innovative way to explore this relationship. Hypothesis We hypothesize that low vitamin D levels will be associated with prevalent SC‐MI independent of traditional CVD risk factors, lifestyle factors, and socioeconomic status. Methods This analysis included 6079 participants (58.3 ± 13.1 years; 54.1% women) without CVD from the third National Health and Nutrition Examination Survey. A multivariable logistic regression model was used to examine the association between vitamin D categories (<20, 20‐29, and >30 ng/mL (reference) and cardiac injury score. Results There was an incremental increase in the prevalence of SC‐MI across vitamin D categories with the highest prevalence in <20 ng/mL, followed by 20 to 29 ng/mL and then >30 ng/mL (trend P‐value <0.0001). There was a statistically significant association between vitamin D deficiency (<20 ng/mL) and SC‐MI (odds ratio [OR] (95% confidence interval [CI]): 1.27 (1.04‐1.55), P = 0.04). This association was stronger in men than women (OR (95% CI): 1.74 (1.32‐2.30) vs 0.94 (0.70‐1.25) respectively; interaction P‐value 0.002). Conclusions Vitamin D deficiency is associated with SC‐MI, especially in men. These findings may further highlight the role of nontraditional risk factors in the development of CVD. The value of vitamin D supplementation in the prevention of myocardial ischemia and injury may warrant investigation.

Potential Beneficial Effects of Vitamin D in Coronary Artery Disease

“…However, this study was conducted in mice, which might make it problematic to directly transfer these findings to the human organism. Overall, these results are consistent with epidemiological studies reporting serum 25(OH)D to be inversely correlated with CAD and myocardial injury [65,68]. However, the possibility of unknown confounding factors in these cross-sectional studies cannot be excluded.…”

“…The third group (reference) with serum-25(OH)D > 30 ng/mL had a prevalence of SC-MI = 19.5%. A comparison of groups one and three revealed that SC-MI was inversely associated with 25(OH)D levels with an odds ratio (OR) of 1.27 (95% CI: 1.04-1.55) after adjustments for potential confounders [65]. Hence, the study found a significant incremental increase in SC-MI prevalence associated with vitamin D deficiency (p = 0.04).…”

“…Likewise, seasonal variation in serum 25(OH)D-levels might be a concern. This is due to fact that information is lacking about the time of year at which the participants had blood samples collected [65]. Even though both studies found strong associations between vitamin D status and CAD, this does not necessarily substantiate causality.…”

“…Using NHANES III data, Ahmad et al [65] examined a possible association between serum vitamin D concentration and subclinical myocardial injury. In this cross-sectional study, recruited individuals were sought to be representative of the background population [66].…”

Vitamin D Low-Levels and Silent Myocardial Ischemia in Type 2 Diabetes: Clinical Correlations and Prognostic Significance

“…In line with other previous large studies that demonstrated a potential correlation between 25 (OH)D de ciency and subclinical myocardial injury and with sensitive neuropathy (22)(23)(24)(25), we hypothesized that vitamin D de ciency is correlated to SMI.…”