To evaluate the role of plasma vitamin D level as a prognostic marker and its relation to in-hospital complications in patients with acute coronary syndrome

Sujit Kumar, Piyush Saxena


Background: Deficiency in 25-hydroxyvitamin D (25[OH] D), the main circulating form of vitamin D in blood, could be involved in the pathogenesis of acute coronary syndromes (ACS). To date, however, the possible prognostic relevance of 25 (OH) D deficiency in ACS patients remains poorly defined. The purpose of this study was to assess the association between 25 (OH) D levels, at hospital admission, with in-hospital complications in an unselected cohort of ACS patients.

Methods: We measured 25 (OH) D in 200 ACS patients at hospital presentation. Vitamin D serum levels >30  ng/mL were considered as normal; levels between 29 and 21  ng/mL were classified as insufficiency, and levels  < 20  ng/mL as deficiency. In-hospital complications were evaluated according to 25 (OH) D levels.

Results: In the study population 85(42.5%) patients had normal 25 (OH) D levels, whereas 36 (18%) and 79 (39.5%) had vitamin D insufficiency and deficiency, respectively. The patients with vitamin D deficiency were associated with a higher risk for several in-hospital MACEs (major adverse clinical events) including mortality and it was statistically significant (P value < 0.05).  The left ventricular function was more severely compromised in patients with vitamin D deficiency and it was statistically significant (P value < 0.05).

Conclusions: In ACS patients, severe vitamin D deficiency is independently associated with poor in-hospital outcomes. Whether low vitamin D levels represent a risk marker or a risk factor in ACS remains to be elucidated.


Acute coronary syndrome, Risk factor, Vitamin D

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Lavie CJ, Lee J, Milani R. Vitamin D and cardiovascular disease. Will it live up to its hype? J Am Coll Cardiol. 2011;58:1547-56.

Vanga S, Good M, Howard P. Role of vitamin D in cardiovascular health. Am J Cardiol. 2010;106:798-805.

Pittas AG, Lau J, Hu FB. The role of vitamin D and calcium in type 2 diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92:2017-29.

Luxmoore JC, Langford HG, Nelson NC. A case-comparison study of hypertension and hyperparathyroidism. J Clin Endocrinol Metab. 1982;55:303-6.

Saleh FN, Schirmer H, Sundsfjord J, Jorde R. Parathyroid hormone and left ventricular hypertrophy. Eur Heart J. 2003;24:2054-60.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-81.

Gonzalez EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol. 2004;24:503-10.

Gotsman I, Shauer A, Zwas DR, Hellman Y, Keren A, Lotan C, Admon al. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail. 2012;14:357-66.

Zittermann A, Schleithoff SS, Koerfer R. Vitamin D and vascular calcification. Curr Opin Lipidol. 2007;18:41-6.

Lee JH, Gadi R, Spertus JA, Tang F, Okeefe JH. Prevalence of vitamin D deficiency in patients with acute myocardial infarction. Am J Cardiol. 2011;107:1636-8.

Khalili H, Talazaz AH, Salarifar M. Serum vitamin D concentration status and its correlation with early biomarkers of remodeling following acute myocardial infarction. Clinical Res Cardiology. 2012;101:321-7.

Correia LCL, Sodrè F, Garcia G, Sabino M, Brito M, Kalil F, et al. Relation of severe deficiency of vitamin D to cardiovascular mortality during acute coronary syndromes. Am J Cardiol. 2013;111:324-7.

Ng LL, Sandhu JK, Squire IB, Davies JE, Jones DJ. Vitamin D and prognosis in acute myocardial infarction. Int J Cardiol. 2013;168:2341-6.

Li YC. Vitamin D regulation of the renin-angiotensin system. J Cell Biochem. 2003;88:327-31.

Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R, et al. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2006;83:754-9.

Ortega A, Perez D, Prada MT, Armengol JJ, Mozo RP, Armengol JJ, González D, Castillo JM, et al. Effect of parathyroid-hormone-related protein on human platelet activation. Clinical Sci. 2007;113:319-27.

Pilz S, Marz W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, et al. Association of Vitamin D deficiency with heart failure and sudden cardiac death in a large cross sectional study of patient referred for coronary angiography. J Clin Endocrinol Metab. 2008;93:3927-35.

Levey AS, Bosch JP, Lewis JB, Gordon CM, Hanley DA, Heaney RP, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999;130:461-70.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-30.

Fabsitz R, Feinleib M. Geographic patterns in county mortality rates from cardiovascular diseases. Am J Epidemiol. 1980;111:315-28.

Zipes DP. Warning: the short days of winter may be hazardous to your health. Circulation. 1999;100:1590-2.

Teng M, Wolf M, Ofsthun MN, Lazarus JM, Hernán MA, Camargo CA Jr, et al. Activated injectable vitamin D and hemodialysis: a historical cohort study. J Am Soc Nephrol. 2005;16:1115-25.

Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007;167:1730-7.

Amrein K, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH, et al. Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011;15:104.

Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol. 2005;45:1397-405.

Marenzi G, Moltrasio M, Assanelli E. Impact of cardiac and renal dysfunction on in hospital morbidity and mortality of patients with acute myocardial infarction undergoing primary angioplasty. Am Heart J. 2007;153:755-62.

Saltzman AJ, Stone GW, Claessen BE, Narula A, Leon-Reyes S, Weisz G, et al. Long-term impact of chronic kidney disease in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. The HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J Am Coll Cardiol Intv. 2011;4:1011-9.

Pittas AG, Chung M, Trikalinos T, Mitri J, Brendel M, Patel K, et al. Systemic review: vitamin D and cardiometabolic outcomes. Ann Intern Med. 2010;152:307-14.

Herrmann M, Sullivan DR, Veillard AS, Mcorquodale T, Straub IR, Scott R, et al. Field study investigators. Serum 25-hydroxyvitamin D: a predictor of macrovascular and microvascular complications in patients with type 2 diabetes. Diab Care. 2015;38:521-8.

Monraats PS, Fang Y, Pons D, Pires NM, Pols HA, Zwinderman AH, et al. Vitamin D receptor: a new risk marker for clinical restenosis after percutaneous coronary intervention. Expert Opin Ther Targets. 2010;14:243-51.

Jorde R, Grimnes G. Vitamin D and metabolic health with special reference to the effect of vitamin D on serum lipids. Prog Lipid Res. 2011;50:303-12.

Wu L, Liu L. Systematic review and meta-analysis evaluating the impact of Vitamin D on the risk of heart failure: new evidence from population-based studies. JCD. 2014;2:159-73.

Stach K, Kalsch AI, Nguyen XD, Elmas E, Kralev S, Lang S, et al. 1 alpha,25-dihydroxyvitamin D3 attenuates platelet activation and the expression of VCAM-1 and MT1-MMP in human endothelial cells. Cardiology. 2011;118:107-15.

Perticone F, Ceravolo R, Pujia A, Ventura G, Iacopino S, Scozzafava A, et al. Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation. 2001;104:191-6.

Kinlay S, Ganz P. Relation between endothelial dysfunction and the acute coronary syndrome: implications for therapy. Am J Cardiol. 2000;86:10-3.

Santulli G, Campanile A, Spinelli L, Assante di Panzillo E, Ciccarelli M, Trimarco B, et al. G protein-coupled receptor kinase 2 in patients with acute myocardial infarction. Am J Cardiol 2011;107:1125-30.

Iaccarino G, Ciccarelli M, Sorriento D. AKT participates in endothelial dysfunction in hypertension. Circulation. 2004;109:2587-93.

Eren E, Ellidag HY, Yılmaz A, Aydın O, Yılmaz N. No association between vitamin D levels and inflammation markers in patients with acute coronary syndrome. Adv Med Sci. 2015;60:89-93.

Rosen CJ. Vitamin D insufficiency. N Engl J Med 2011;364:248-54.