Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: A 20-year study of a community-based cohort

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Abstract

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.

Original languageEnglish
Pages (from-to)154-163
Number of pages10
JournalClinical Endocrinology
Volume88
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

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Cardiovascular Diseases
Mortality
Serum
Heart Failure
25-hydroxyvitamin D
North America
Health Surveys
Vitamin D
Cohort Studies
Prospective Studies

Cite this

@article{92065dd412b44835b370a933d117d68f,
title = "Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: A 20-year study of a community-based cohort",
abstract = "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.",
keywords = "Australia, cardiovascular disease, follow-up study, health survey, heart failure, mortality, vitamin D",
author = "Kun Zhu and Matthew Knuiman and Mark Divitini and Joseph Hung and Lim, {Ee Mun} and Cooke, {Brian R.} and Walsh, {John P.}",
year = "2018",
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doi = "10.1111/cen.13485",
language = "English",
volume = "88",
pages = "154--163",
journal = "Clinical Endocrinology",
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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

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U2 - 10.1111/cen.13485

DO - 10.1111/cen.13485

M3 - Article

VL - 88

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JO - Clinical Endocrinology

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