Vitamin D deficiency is associated with significant coronary stenoses in asymptomatic African American chronic cocaine users

Abstract

Background: Chronic cocaine use may lead to premature atherosclerosis, however, the prevalence of and risk factors for coronary artery disease in asymptomatic cocaine users have not been reported.

Methods: Between August 2007 and June 2010, 385 African American chronic cocaine users aged 25 to 54 years were consecutively enrolled in a study to investigate the prevalence of CT angiographically-defined significant (≥ 50%) coronary stenosis and related risk factors. Sociodemographic, drug-use behavior, medical history and medication data were obtained by interview and confirmed by medical chart review. Clinical examinations were performed as well as extensive laboratory tests including those for fasting lipid profiles, HIV, high sensitivity C-reactive protein, and vitamin D. Contrast-enhanced coronary CT angiography was performed.

Results: Significant coronary stenosis was detected in 52 of 385 participants (13.5%). The prevalences were 12% and 30% in those with low risk and with middle-high risk Framingham score, respectively. In those with low risk scores, the prevalences of significant stenosis were 10% and 18% in those without and with vitamin D deficiency, defined as serum 25-(OH) vitamin D< 10 ng/mL (p=0.08). Multiple logistic regression analysis revealed that vitamin D deficiency (adjusted OR=2.18, 95% CI: 1.07-4.43) is independently associated with the presence of significant coronary stenosis after controlling for traditional risk factors.

Conclusions: The study indicates that the prevalence of significant coronary stenoses is high in asymptomatic young and middle-aged African American chronic cocaine users. These findings emphasize the importance of aggressive reduction of risk factors, including vitamin D deficiency in this population.

Figure 1

Prevalence of Significant Coronary Stenosis, by Quartile of Serum 25-dihydroxyvitamin D. For all study participants, the prevalences were 19.7% (15/76), 11.4% (12/105), 14.0% (15/107), and 10.3% (10/97) in those whose 25-dihydroxyvitamin D was <10 ng/mL, whose 25-dihydroxyvitamin D was between 10 and 14.9 ng/mL, whose 25-dihydroxyvitamin D was between 15 and 22.9 ng/mL, and whose 25-dihydroxyvitamin D was ≥23 ng/mL, respectively (10, 15, and 23 ng/mL were the 25^th, 50^th, and 75^th percentiles of serum 25-dihydroxyvitamin D). For those with low risk according to the Framingham score, the prevalences were 17.9% (12/67), 12.0% (12/100), 9.7% (9/93), and 9.1% (8/88) in those whose 25-dihydroxyvitamin D was <10 ng/mL, whose 25-dihydroxyvitamin D was between 10 and 14.9 ng/mL, whose 25-dihydroxyvitamin D was between 15 and 22.9 ng/mL, and whose 25-dihydroxyvitamin D was ≥23 ng/mL, respectively.

Figure 2

Prevalence of Significant Coronary Stenosis, by Framingham Risk Score Category and Vitamin D Deficiency Status. The prevalences were 10.3% (29/281), 17.9% (12/67), 28.6% (8/28), and 33.3% (3/9) in those with low risk according to the Framingham score and without vitamin D deficiency, those with low risk according to the Framingham score and with vitamin D deficiency, those with moderate-high risk according to the Framingham score and without vitamin D deficiency, and those with moderate-high risk according to the Framingham score and with vitamin D deficiency, respectively. Low risk = the Framingham risk score <10, High risk = the Framingham risk score ≥10, defD (−) = without vitamin D deficiency, defD (+) = with vitamin D deficiency.