Abstract
BackgroundLow levels of vitamin D have been related to increased mortality and morbidity in several non-diabetic studies. We aimed to prospectively study relationships between serum 25-OH vitamin D3 (vitamin D) and of serum parathyroid hormone (PTH) to total mortality in type 2 diabetes. We also aimed to compare the levels of these potential risk-factors in patients with and without diabetes.MethodsThe main study design was prospective and observational. We used baseline data from 472 men and 245 women who participated in the “Cardiovascular Risk factors in Patients with Diabetes—a Prospective study in Primary care” study. Patients were 55–66 years old at recruitment, and an age-matched non-diabetic sample of 129 individuals constituted controls for the baseline data. Carotid-femoral pulse-wave velocity (PWV) was measured with applanation-tonometry and carotid intima-media thickness (IMT) with ultrasound. Patients with diabetes were followed for all-cause mortality using the national Swedish Cause of Death Registry.ResultsLevels of vitamin D were lower in patients with diabetes than in controls, also after correction for age and obesity, while PTH levels did not differ. Nine women and 24 men died during 6 years of median follow up of the final cohort (n = 698). Vitamin D levels were negatively related to all-cause mortality in men independently of age, PTH, HbA1c, waist circumference, 24-h systolic ambulatory-blood pressure (ABP) and serum-apoB (p = 0.049). This finding was also statistically significant when PWV and IMT were added to the analyses (p = 0.028) and was not affected statistically when medications were also included in the regression-analysis (p = 0.01). In the women with type 2 diabetes, levels of PTH were positively related with all-cause mortality in the corresponding calculations (p = 0.016 without PWV and IMT, p = 0.006 with PWV and IMT, p = 0.045 when also adding medications to the analysis), while levels of vitamin D was without statistical significance (p >0.9).ConclusionsSerum vitamin D in men and serum PTH in women give prognostic information in terms of total-mortality that are independent of regular risk factors in addition to levels of ABP, IMT and PWV.Trial registrationClinicalTrials.gov: NCT01049737
Highlights
Vitamin D is stored in adipose tissue and liver in an inactive form, and serum levels of vitamin D are negatively related to adiposity [1]
Vitamin D and parathyroid hormone (PTH) levels according to diabetes status Compared with 129 non-diabetic controls (67 women and 62 men), the 717 patients with type 2 diabetes had significantly lower levels of vitamin D, but there was no significant difference concerning levels of PTH (Table 1)
Regression analysis of total mortality in relation to levels of serum vitamin D adjusted for age, waist circumference, HbA1c, apoB1, mean systolic 24 h ambulatory blood pressure levels and serum PTH in men Systolic mean ambulatory-blood pressure (ABP) 0.970 (0.933-1.009)
Summary
Vitamin D is stored in adipose tissue and liver in an inactive form, and serum levels of vitamin D are negatively related to adiposity [1]. Low levels of serum vitamin D (25-hydroxyvitamin D3) have been linked with an increased risk for mortality in different non-diabetic populations [6, 7]. Arguing against a simple inverse relationship between levels of vitamin D and risk for disease was the quite recent finding of increased mortality rates in two large studies among subjects with high levels of vitamin D [11, 12]. High levels of PTH have been linked with increased arterial calcification in a population-based study in Sweden [13] and it is well known that secondary hyperparathyroidism is an indicator of poor outcome in renal diseases in which activation of vitamin D is deficient [14]. We aimed to compare the levels of these potential risk-factors in patients with and without diabetes
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