Abstract
The study aimed to examine the joint predicting effect of serum 25(OH) D (a biomarker of vitamin D level in blood) and C-reactive Protein (CRP) concentration on the risk of mortality from Coronary Heart Disease (CHD) and all-causes in patients with type 2 Diabetes Mellitus (T2DM) using data from the third National Health and Nutrition Examination Survey (NHANES III). Of 14965 subjects aged ≥ 30 years who participated in the NHANESIII, 2146 patients with T2DM at baseline (1988-1994) were followed up through December 31 of 2006. The associations of baseline serum 25(OH) D and CRP with outcomes were examined prospectively using Cox’s hazard proportional regression models. The results show that during a median follow-up of 12.3 years, 1257 (58.6%) of the patients with T2DM died, and 370 deaths were from CHD. Multivariate adjusted Cox’s models indicate that decreased 25(OH) D level significantly predicted risk of death. The corresponding hazard ratios for the risk of CHD mortality among those with serum 25(OH) D levels 20-29.9, 10-19.9, and <10 ng/mL were 1.35, 1.38 and 2.19, as compared to those with 25(OH) D ≥ 30 ng/mL, respectively. Similar associations between decreased 25(OH) D and risk of all-cause mortality were observed. Furthermore, a joint effect of decreased 25(OH) D and increased CRP significantly predicted an increased risk of CHD and all-cause mortality. In conclusion, using data from a nationally representative and longitudinal survey, findings from the study suggest that decreased serum vitamin D and increased CRP concentrations significantly predicted the risk of CHD and all-cause mortality in patients withT2DM.
Highlights
Levels of serum 25-hydroxyvitamin D [25(OH) D, a biomarker of serum vitamin D concentration] vary considerably among individuals mainly because of differences in sun exposure and skin color and the presence of risk factors such as, cigarette smoking, obesity, Diabetes Mellitus (DM) or other co morbidities
Cox’s model analyses (Table 2) indicate that patients with serum 25(OH) D
The main findings of the present study are that low serum 25(OH) D concentration was significantly associated with an increased risk of mortality from CHD and all-causes in patients with type 2 DM (T2DM), and that there were significant joint effects of low serum 25(OH) D and increased CRP concentrations on the risks of CHD and all-cause mortality
Summary
Levels of serum 25-hydroxyvitamin D [25(OH) D, a biomarker of serum vitamin D concentration] vary considerably among individuals mainly because of differences in sun exposure and skin color and the presence of risk factors such as, cigarette smoking, obesity, Diabetes Mellitus (DM) or other co morbidities. There is a significant longitudinal association of decreased serum 25(OH) D concentration with an increased risk of CHD and all-cause mortality in patients with T2DM. There is a significantly joint or interactive effect of decreased 25(OH) D and increased serum CRP levels on the risk of CHD and all-cause mortality. To test these hypotheses, data from the third National Health and Nutrition Examination Survey (NHANES III), a nationally representative longitudinal study, was used in the study [11]
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