Vitamin D Inadequacy Is Associated with Significant Coronary Artery Stenosis in a Community-Based Elderly Cohort: The Korean Longitudinal Study on Health and Aging

Abstract

Recent studies suggest an association between vitamin D activity and cardiometabolic risk. We investigated vitamin D status and its association with subclinical atherosclerosis in a population-based cohort study, the Korean Longitudinal Study on Health and Aging (KLoSHA). Participants were 439 men and 561 women aged 65 yr or older who were recruited by random stratified sampling for KLoSHA. Anthropometric and biochemical parameters, the concentration of 25-hydroxyvitamin D (25-OHD), and intact PTH were measured. We evaluated the coronary artery calcium score and stenosis using multidetector-row cardiac computed tomography, the intima-media thickness using carotid sonography, pulse wave velocity, and the ankle-brachial index. Among the participants, 49.8, 44.2, and 6.0% had 25-OHD deficiency (<15 ng/ml), insufficiency (15-29.9 ng/ml), and adequacy (≥30 ng/ml), respectively. The frequency of coronary artery stenosis (>50%) differed between 25-OHD categories: 18.5, 12.9, and 1.9% in the 25-OHD-deficient, -insufficient, and -adequate groups, respectively (P < 0.05). After adjusting for cardiometabolic risks and intact PTH concentration, multivariate regression analysis showed that participants with a low 25-OHD concentration had a higher risk of significant coronary artery stenosis; the odds ratios were 2.08 for 25-OHD concentration of 15-29.9 ng/ml vs. at least 30 ng/ml and 3.12 for 25-OHD concentration below 15 ng/ml vs. at least 30 ng/ml (both P < 0.05). The association between 25-OHD inadequacy and subclinical atherosclerosis underscores the clinical implications of vitamin D status. An intervention strategy to increase vitamin D level through vitamin D-fortified diet and adequate sun exposure may mitigate the consequences of vitamin D deficiency.