Vitamin D Levels and Asymptomatic Coronary Artery Disease in Type 2 Diabetic Patients With Elevated Urinary Albumin Excretion Rate

Abstract

OBJECTIVE Coronary artery disease (CAD) is the major cause of morbidity and mortality in type 2 diabetic patients. Severe vitamin D deficiency has been shown to predict cardiovascular mortality in type 2 diabetic patients. RESEARCH DESIGN AND METHODS We investigated the association among severe vitamin D deficiency, coronary calcium score (CCS), and asymptomatic CAD in type 2 diabetic patients with elevated urinary albumin excretion rate (UAER) >30 mg/24 h. This was a cross-sectional study including 200 type 2 diabetic patients without a history of CAD. Severe vitamin D deficiency was defined as plasma 25-hydroxyvitamin D ( p -25[OH]D3) <12.5 nmol/L. Patients with plasma N-terminal pro-brain natriuretic peptide >45.2 ng/L or CCS ≥400 were stratified as being high risk for CAD ( n = 133). High-risk patients were examined by myocardial perfusion imaging (MPI; n = 109), computed tomography angiography ( n = 20), or coronary angiography (CAG; n = 86). Patients’ p -25(OH)D3 levels were determined by high-performance liquid chromatography/tandem mass spectrometry. RESULTS The median (range) vitamin D level was 36.9 (3.8–118.6) nmol/L. The prevalence of severe vitamin D deficiency was 9.5% (19/200). MPI or CAG demonstrated significant CAD in 70 patients (35%). The prevalence of CCS ≥400 was 34% (68/200). Severe vitamin D deficiency was associated with CCS ≥400 (odds ratio [OR] 4.3, 95% CI [1.5–12.1], P = 0.005). This association persisted after adjusting for risk factors (4.6, 1.5–13.9, P = 0.007). Furthermore, severe vitamin D deficiency was associated with asymptomatic CAD (adjusted OR 2.9, 1.02–7.66, P = 0.047). CONCLUSIONS In high-risk type 2 diabetic patients with elevated UAER, low levels of vitamin D are associated with asymptomatic CAD.

Measuring coronary artery calcification: Is serum vitamin D relevant?

“…Two studies compared high CAC groups to low CAC groups across vitamin D levels [14,15]. One compared prevalence of CAC>100 while the other had a cut-off of CAC >400.…”

Assessment of serum 25-hydroxy vitamin D improves coronary heart disease risk stratification in patients with type 2 diabetes

“…26 Another population-based study in patients with type 2 diabetes and elevated urinary albumin excretion rate showed that severe 25(OH)VitD deficiency (plasma level b12.5 nmol/L) is significantly associated with subclinical atherosclerosis (defined as elevated coronary calcium score ≥400). 27 In contrast, a recently published cohort study failed to demonstrate significant association between 25(OH)VitD deficiency and future development of CHD events. 28 It included 936 veterans with type 2 diabetes (96.9% men, mean age of 59.7 ± 8.4 years).…”

“…As noted, 25(OH)VitD is associated with improved endothelial function, 30 decreased vascular stiffness, 26 and decreased coronary calcification. 27 Growing body of evidence suggests that 25(OH)VitD deficiency could take part in developing hypertension and diabetes. 31 For instance, serum 25(OH)VitD may decrease the activity of renin-angiotensin-aldosterone system, which subsequently reduces blood pressure and decreases the risk of left ventricular hypertrophy.…”

Relationship between 25-hydroxyvitamin D Level and Metabolic Control and Albumin Excretion Rate in Elderly Patients with Type 2 Diabetes Mellitus

“…Also, vitamin D supplementation may have a role in modifying other aspects of the metabolic and cardiovascular derangements that accompany type 2 diabetes [12]. Recently, Joergensen et al [13] suggested that in high-risk type 2 diabetic patients with elevated urinary albumin excretion rate, low levels of vitamin D were associated with asymptomatic coronary artery disease.…”