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Meta-Analysis
. 2023 Aug 21;38(33):e260.
doi: 10.3346/jkms.2023.38.e260.

Circulating Vitamin D Level and Risk of Sudden Cardiac Death and Cardiovascular Mortality: A Dose-Response Meta-Analysis of Prospective Studies

So Yeon Kong  1 , Eujene Jung  1   2 , Seung-Sik Hwang  3 , Young Sun Ro  1 , Sang Do Shin  1 , Kyoung-Chul Cha  4 , Sung Oh Hwang  4
Affiliations
Meta-Analysis

Circulating Vitamin D Level and Risk of Sudden Cardiac Death and Cardiovascular Mortality: A Dose-Response Meta-Analysis of Prospective Studies

So Yeon Kong et al. J Korean Med Sci. .

Abstract

Background: We conducted a comprehensive meta-analysis of prospective cohort studies to analyze the effect of circulating vitamin D level on the risk of sudden cardiac death (SCD) and cardiovascular disease (CVD) mortality.

Methods: Prospective cohort studies evaluating the association between circulating vitamin D and risk of SCD and CVD mortality were systematically searched in the PubMed and Embase. Extracted data were analyzed using a random effects model and results were expressed in terms of hazard ratio (HR) and 95% confidence interval (CI). Restricted cubic spline analysis was used to estimate the dose-response relationships.

Results: Of the 1,321 records identified using the search strategy, a total of 19 cohort studies were included in the final meta-analysis. The pooled estimate of HR (95% CI) for low vs. high circulating vitamin D level was 1.75 (1.49-2.06) with I² value of 30.4%. In subgroup analysis, strong effects of circulating vitamin D were observed in healthy general population (pooled HR, 1.84; 95% CI, 1.43-2.38) and the clinical endpoint of SCD (pooled HRs, 2.68; 95% CI, 1.48-4.83). The dose-response analysis at the reference level of < 50 nmol/L showed a significant negative association between circulating vitamin D and risk of SCD and CVD mortality.

Conclusion: Our meta-analysis of prospective cohort studies showed that lower circulating vitamin D level significantly increased the risk of SCD and CVD mortality.

Keywords: Cardiac; Cardiovascular Disease; Death; Meta-Analysis; Sudden; Vitamin D.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Flowchart of the study selection (PRISMA).
NHANES = National Health and Nutrition Examination Survey, CHS = Cardiovascular Health Study, LURIC = Ludwigshafen Risk and Cardiovascular Health.
Fig. 2
Fig. 2. Forest plot for study-specific and pooled hazard ratios and 95% confidence intervals of risk of sudden cardiac death and cardiovascular disease mortality for lowest versus highest categories of circulating vitamin D levels. The overall effect was obtained from a random-effect model.
HR = hazard ratio, CI = confidence interval.
Fig. 3
Fig. 3. Funnel plot of sudden cardiac death and cardiovascular disease mortality for lowest versus highest categories of circulating vitamin D level.
Fig. 4
Fig. 4. Forest plot for stratified meta-analysis and their pooled hazard ratios and 95% confidence intervals of the risk of sudden cardiac death and cardiovascular disease mortality for lowest versus highest categories of circulating vitamin D levels by (A) pre-existing comorbidity status and (B) endpoints. The overall effects for each stratified group were obtained from a random-effect model.
HR = hazard ratio, CI = confidence interval, CVD = cardiovascular disease, CKD = chronic kidney disease, SCD = sudden cardiac death.
Fig. 5
Fig. 5. Dose-response meta-analysis between circulating vitamin D level and the hazard ratio of sudden cardiac death and cardiovascular disease mortality with reference value of (A) 100 nmol/L and (B) 50 nmol/L, which is the approximate sufficient level of serum 25(OH)D recommended by the Institute of Medicine. The solid line represents point estimates with the use of a restricted cubic splines model, and the dashed lines indicate 95% confidence intervals.
HR = hazard ratio.
See this image and copyright information in PMC

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