The role of dietary vitamin D intake on 10-year cardiovascular disease incidence, intermediate cardiometabolic risk factors and surrogate markers: highlights from ATTICA prospective study

Abstract

Abstract Background/Introduction Increasing vitamin D intake through food supplements or fortification is far from revealing strong contribution to cardiac health. On the other side, the separate evaluation of dietary vitamin D intake with cardiac health is limited. Purpose The aim of the present work was to evaluate the association between dietary vitamin D intake and 10-year first fatal/non fatal CVD, conventional CVD risk factors and surrogate markers related with inflammation, coagulation, insulin resistance, liver and renal function. Methods ATTICA prospective study was conducted during 2001–2012 and included n=1,514 men and n=1,528 women (aged >18 years old) from the greater Athens area, Greece. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Daily intake of vitamin D was calculated through standardized food database. Follow-up assessment of CVD (2011–2012) was achieved in n=2,020 participants (n=317 cases). Results Ranking from 1st to 3rd vitamin D tertile, CVD event was for men 24%, 17% and 12% (p=0.002) and for women 14%, 10% and 11% (p=0.59), respectively. Multiadjusted analysis revealed inverse associations between vitamin D and CVD in total sample [Hazard Ratio (HR)=0.76 95% Confidence Interval (95% CI) (0.60, 0.97)] and in men [HR=0.66 95% CI (0.49, 0.89)], lost after adjusting for inflammation/coagulation markers; for women no significant trends against hard CVD endpoints were observed. Regarding 10-year onset of conventional risk factors, inverse associations of vitamin D with hypertension in men [HR=0.62 95% CI (0.39, 0.99)] and transition to metabolically unhealthy status in women [HR=0.69 95% CI (0.51, 0.93)] were observed. Multiadjusted analyses revealed significant inverse associations for C-reactive protein, interleukin-6 and fibrinogen in both sexes while only in women for insulin resistance. Conclusions Contradicting the neutral/modest associations in vitamin D supplementation trials, the present work revealed that increased food-generated vitamin D may protect against hard and intermediate CVD endpoints implying the existence of different paths between sexes. Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].