25-hydroxyvitamin D levels inversely associate with risk for developing coronary artery calcification

Abstract

Vitamin D deficiency associates with increased risk for cardiovascular events and mortality, but the mechanism driving this association is unknown. Here, we tested whether circulating 25-hydroxyvitamin D concentration associates with coronary artery calcification (CAC), a measure of coronary atherosclerosis, in the Multi-Ethnic Study of Atherosclerosis. We included 1370 participants: 394 with and 976 without chronic kidney disease (estimated GFR <60 ml/min per 1.73 m(2)). At baseline, CAC was prevalent among 723 (53%) participants. Among participants free of CAC at baseline, 135 (21%) developed incident CAC during 3 yr of follow-up. Lower 25-hydroxyvitamin D concentration did not associate with prevalent CAC but did associate with increased risk for developing incident CAC, adjusting for age, gender, race/ethnicity, site, season, physical activity, smoking, body mass index, and kidney function. Further adjustment for BP, diabetes, C-reactive protein, and lipids did not alter this finding. The association of 25-hydroxyvitamin D with incident CAC seemed to be stronger among participants with lower estimated GFR. Circulating 1,25-dihydroxyvitamin D concentrations among participants with chronic kidney disease did not significantly associate with prevalent or incident CAC in adjusted models. In conclusion, lower 25-hydroxyvitamin D concentrations associate with increased risk for incident CAC. Accelerated development of atherosclerosis may underlie, in part, the increased cardiovascular risk associated with vitamin D deficiency.

Figure 1.

(A and B) Prevalence (A) and 3-yr cumulative incidence (B) of CAC, by eGFR and 25(OH)D concentration, adjusted for age, gender, and race/ethnicity.

Figure 2.

Subgroup associations of circulating 25(OH)D concentration with incident CAC. Circles represent point estimates; horizontal bars represent 95% CIs. Risk is assessed per 10-ng/ml lower 25(OH)D concentration, adjusted for age, gender, race/ethnicity, site, season, measurement batch, physical activity, BMI, smoking, diabetes, BP, CRP, total cholesterol, HDL cholesterol, and triglycerides. Shown in parentheses are numbers of participants at risk/numbers of participants with incident CAC.