TY - JOUR
T1 - Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events
T2 - A 20-year study of a community-based cohort
AU - Zhu, Kun
AU - Knuiman, Matthew
AU - Divitini, Mark
AU - Hung, Joseph
AU - Lim, Ee Mun
AU - Cooke, Brian R.
AU - Walsh, John P.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective: Prospective studies, mostly from Europe and North America, suggest that serum 25-hydroxyvitamin D (25(OH)D) is inversely associated with mortality and cardiovascular disease (CVD) risk. Data from other regions are limited, and threshold levels for adverse cardiovascular outcomes are uncertain. We examined serum 25(OH)D as a predictor of total mortality and cardiovascular outcomes in an Australian cohort. Design: A 20-year, community-based cohort study. Patients: Participants in the 1994/1995 Busselton Health Survey (n = 3946, baseline age 25-84 years). Measurements: Baseline serum 25(OH)D and mortality and cardiovascular outcomes to 2014 obtained by record linkage. Results: The mean serum 25(OH)D concentration was 60.6 ± 18.0 nmol/L. During 20-year follow-up (excluding the first 2 years), 889 participants died (including 363 from CVD) and 944 experienced a CVD event (including 242 with heart failure). In the full cohort, controlling for Framingham risk score variables, higher baseline 25(OH)D was associated with significantly reduced all-cause mortality (adjusted HR 0.83 per SD increment of 25(OH)D, 95% CI 0.77-0.90), CVD death (HR 0.85, 95% CI 0.74-0.96) and heart failure (HR 0.81, 95% CI 0.69-0.94), but not CVD events (HR 0.99, 0.92-1.07). In restricted cubic spline regression models, serum 25(OH)D below 65 and 55 nmol/L was associated with higher total mortality and higher CVD mortality/heart failure, respectively. In participants without CVD at baseline (n = 3220), results were similar, but hazard ratios were attenuated and associations with CVD mortality no longer significant. Conclusions: In an Australian community-based cohort, baseline vitamin D levels below 55-65 nmol/L are predictive of all-cause mortality, CVD death and heart failure.
AB - Objective: Prospective studies, mostly from Europe and North America, suggest that serum 25-hydroxyvitamin D (25(OH)D) is inversely associated with mortality and cardiovascular disease (CVD) risk. Data from other regions are limited, and threshold levels for adverse cardiovascular outcomes are uncertain. We examined serum 25(OH)D as a predictor of total mortality and cardiovascular outcomes in an Australian cohort. Design: A 20-year, community-based cohort study. Patients: Participants in the 1994/1995 Busselton Health Survey (n = 3946, baseline age 25-84 years). Measurements: Baseline serum 25(OH)D and mortality and cardiovascular outcomes to 2014 obtained by record linkage. Results: The mean serum 25(OH)D concentration was 60.6 ± 18.0 nmol/L. During 20-year follow-up (excluding the first 2 years), 889 participants died (including 363 from CVD) and 944 experienced a CVD event (including 242 with heart failure). In the full cohort, controlling for Framingham risk score variables, higher baseline 25(OH)D was associated with significantly reduced all-cause mortality (adjusted HR 0.83 per SD increment of 25(OH)D, 95% CI 0.77-0.90), CVD death (HR 0.85, 95% CI 0.74-0.96) and heart failure (HR 0.81, 95% CI 0.69-0.94), but not CVD events (HR 0.99, 0.92-1.07). In restricted cubic spline regression models, serum 25(OH)D below 65 and 55 nmol/L was associated with higher total mortality and higher CVD mortality/heart failure, respectively. In participants without CVD at baseline (n = 3220), results were similar, but hazard ratios were attenuated and associations with CVD mortality no longer significant. Conclusions: In an Australian community-based cohort, baseline vitamin D levels below 55-65 nmol/L are predictive of all-cause mortality, CVD death and heart failure.
KW - Australia
KW - cardiovascular disease
KW - follow-up study
KW - health survey
KW - heart failure
KW - mortality
KW - vitamin D
UR - http://www.scopus.com/inward/record.url?scp=85030709265&partnerID=8YFLogxK
U2 - 10.1111/cen.13485
DO - 10.1111/cen.13485
M3 - Article
C2 - 28949411
AN - SCOPUS:85030709265
SN - 0300-0664
VL - 88
SP - 154
EP - 163
JO - Clinical Endocrinology
JF - Clinical Endocrinology
IS - 1
ER -