Preventive cardiology
Relation of Vitamin D Deficiency to Cardiovascular Risk Factors, Disease Status, and Incident Events in a General Healthcare Population

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Vitamin D recently has been proposed to play an important role in a broad range of organ functions, including cardiovascular (CV) health; however, the CV evidence-base is limited. We prospectively analyzed a large electronic medical records database to determine the prevalence of vitamin D deficiency and the relation of vitamin D levels to prevalent and incident CV risk factors and diseases, including mortality. The database contained 41,504 patient records with at least one measured vitamin D level. The prevalence of vitamin D deficiency (≤30 ng/ml) was 63.6%, with only minor differences by gender or age. Vitamin D deficiency was associated with highly significant (p <0.0001) increases in the prevalence of diabetes, hypertension, hyperlipidemia, and peripheral vascular disease. Also, those without risk factors but with severe deficiency had an increased likelihood of developing diabetes, hypertension, and hyperlipidemia. The vitamin D levels were also highly associated with coronary artery disease, myocardial infarction, heart failure, and stroke (all p <0.0001), as well as with incident death, heart failure, coronary artery disease/myocardial infarction (all p <0.0001), stroke (p = 0.003), and their composite (p <0.0001). In conclusion, we have confirmed a high prevalence of vitamin D deficiency in the general healthcare population and an association between vitamin D levels and prevalent and incident CV risk factors and outcomes. These observations lend strong support to the hypothesis that vitamin D might play a primary role in CV risk factors and disease. Given the ease of vitamin D measurement and replacement, prospective studies of vitamin D supplementation to prevent and treat CV disease are urgently needed.

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Methods

We prospectively studied the electronic medical record database of the integrated Intermountain Healthcare system to address 4 objectives in a general healthcare population: (1) to determine the prevalence of vitamin D deficiency and insufficiency in subjects with measured vitamin D levels; (2) to evaluate the relation of vitamin D levels to prevalence and incidence of prespecified CV risk factors; (3) to assess the relation of vitamin D levels to prespecified CV conditions; and (4) to

Results

In a search of the Intermountain electronic medical record database, 41,504 patients were found with at least one measured vitamin D level; 11,088 (26.7%) had 2 measurements, 3,950 (9.5%) had 3 measurements, and 1,703 (4.1%) had >3 measurements, for a total of 58,245 measured levels. The age and gender distribution is listed in Table 1.

The distribution of vitamin D levels by category is shown in Figure 1. Only minor differences among categories were noted by gender or age (Table 1). Although

Discussion

Vitamin D has increasingly been recognized to play a role in a broad range of bodily functions beyond bone health, including CV health.1, 2, 3 In parallel, the recognition of the presence of widespread vitamin D deficiency is increasing.1, 2, 3 The consequences of this growing epidemic of vitamin D deficiency are still not well understood. However, recent reports of the associations of vitamin D deficiency with multiple CV conditions have been of great interest, suggesting the need for

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This study was generously supported by the Del Loy Hansen Foundation, Logan, Utah and the Deseret Foundation, Salt Lake City, Utah.

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