Vitamin D Predicts All-Cause and Cardiac Mortality in Females with Suspected Acute Coronary Syndrome: A Comparison with Brain Natriuretic Peptide and High-Sensitivity C-Reactive Protein

Abstract

Vitamin D may not only reflect disease but may also serve as a prognostic indicator. Our aim was to assess the gender-specific utility of vitamin D measured as 25-hydroxy-vitamin D [25(OH)D] to predict all-cause and cardiac death in patients with suspected acute coronary syndrome (ACS) and to compare its prognostic utility to brain natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hsCRP). Blood samples were harvested on admission in 982 patients. Forty percent were women (65.9 ± 12.6 years). Mortality was evaluated in quartiles of 25(OH)D, BNP, and hsCRP, respectively, during a 5-year follow-up, applying univariate and multivariate analyses. One hundred and seventy-three patients died; 78 were women. In 92 patients (37 women), death was defined as cardiac. In women, the univariate hazard ratio (HR) for total death of 25(OH)D in Quartile (Q) 2 versus Q1, Q3 versus Q1, and Q4 versus Q1 was 0.55 (95% CI 0.33–0.93), 0.29 (95% CI 0.15–0.55), and 0.13 (95% CI 0.06–0.32), respectively. In females, it was an independent predictor of total and cardiac death, whereas BNP and hsCRP were less gender-specific. No gender differences in 25(OH)D were noted in a reference material. Accordingly, vitamin D independently predicts mortality in females with suspected ACS.

Low Vitamin D Levels Are Associated with Higher Opioid Dose in Palliative Cancer Patients – Results from an Observational Study in Sweden

“…In fact, this is supported by several prospective studies where a low vitamin D level has been shown to predict a worse outcome and also a shorter life span in patients with several different cancer forms, including colorectal and renal cancer [ 26 – 29 ]. Moreover, several large meta-analyses have found that low vitamin D levels are associated with an increased overall mortality and also with death caused by cancer [ 14 , 15 , 30 ]. Thus, it is possible that vitamin D has a true effect on pain mechanisms in cancer patients and that the confounding effect of age, can be explained by the fact that patients with a high vitamin D level survive longer with their cancers.…”

“…Several randomized controlled trials (RCTs) show beneficial effects of vitamin supplementation against infections [ 11 – 13 ]. Moreover, observational studies have shown that low vitamin D-levels are associated with increased all-cause mortality [ 14 , 15 ]. In a meta-analysis of 159 RCTs it was shown that treatment with vitamin D 3 was associated with decreased mortality, and especially mortality caused by cancer [ 16 ].…”

Sex differences in ischemic heart disease and heart failure biomarkers

“…For future personalized diagnosis and prognosis in ACS and HF patients, a temporal multimarker approach could be employed to monitor the functions of different biological pathways over time. For example, markers for status of cardiac damage (hs-cTnI), markers for pathophysiological status (CRP and other cytokines), and markers for cardiac dysfunction (BNP) can be monitored over time as a multi-marker panel [ 56 – 58 ].…”

Prognostic Utility of Vitamin D in Acute Coronary Syndrome Patients in Coastal Norway

“…The prognostic utility of vitamin D in relation to long-term CV outcomes has been evaluated in subjects without a history of CVD, as in the Framingham Offspring study [ 13 ] and in patients with established CVD [ 14 , 15 ]. We have previously shown that 2- and 5-year total and cardiac mortality is decreased in the highest as compared to the lowest quartile of vitamin D in a coronary chest-pain population living at altitudes exceeding 1000 meters in subtropical northern Argentina [ 16 ], and this relationship is stronger in females than in males [ 17 ].…”