Association of Vitamin D Deficiency and Myocardial Infarction

Abstract & Commentary

By Harold L. Karpman, MD, FACC, FACP, Clinical Professor of Medicine, UCLA School of Medicine. Dr. Karpman serves on the speakers bureau for Forest Laboratories.

Synopsis: Vitamin D deficiency was found to be present in almost all patients entering with acute myocardial infarctions in a 20-hospital multicenter study.

Source: Lee JH, et al. Prevalence of vitamin D deficiency in patients with acute myocardial infarction. Am J Cardiol 2011;107:1636-1638.

Numerous reports have clearly outlined the association between cardiovascular disease (CVD) and 25-hydroxyvitamin D (vitamin D) deficiency.1-5 However, the prevalence of vitamin D deficiency in patients presenting with an acute myocardial infarction (AMI) has not been previously reported. Obviously, this information would be most important to know because vitamin D deficiency is readily treatable and, if it is present with significant frequency in patients with AMI, vitamin D administration might be an important and easy way to reduce the incidence of AMIs.

Lee and colleagues performed a substudy analyzing the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) registry in order to investigate the prevalence of vitamin D deficiency at the time of AMI care.6 Vitamin D deficiency was assessed in 239 subjects enrolled in a 20-hospital prospective myocardial infarction registry. Of the 239 patients, 179 (75%) were considered to be vitamin D deficient (vitamin D level below 20 ng/mL) and 50 (21%) were vitamin D insufficient (vitamin D level between 20-30 ng/dL). Vitamin D deficiency was found to be more common in non-Caucasian patients and in those with lower social support, with lower activity levels, in diabetics, and in subjects who had no medical insurance. They concluded that vitamin D deficiency was present in almost all patients with AMI since 96% of the patients in the study were found to have abnormally low vitamin D levels.

Commentary

Lee et al's finding of an extraordinarily high prevalence of vitamin D deficiency or insufficiency in patients admitted with an AMI is consistent with published data associating CVD and many of its risk factors with vitamin D deficiency.4 The authors also confirmed previously described associations between demographic traits and vitamin D deficiency in those subjects with darker skin (i.e., lighter skinned individuals can produce larger amounts of vitamin D with a fixed amount of ultraviolet B radiation),7,8 diabetes mellitus,9 and higher body mass indices.5 It has been suggested that vitamin D deficiency is significantly reduced in obese individuals because the vitamin is sequestered in adipose tissue.10 One of the major limitations of the Lee study is that because of the overwhelming proportion of patients who were vitamin D deficient or insufficient, it was not surprising to find that the study lacked an adequate control group for comparison.

The results of the current study leave little question that vitamin D deficiency or insufficiency is present in almost all patients with AMI. Obviously, one cannot conclude that vitamin D deficiency or insufficiency is a contributing cause of AMI. However, there seems to be little question that clinicians should measure vitamin D levels regularly in all of their patients — especially in those who are at risk for AMI — and should treat any detected deficiency of vitamin D with oral vitamin D supplementation.

References

1. Zittermann A, et al. Vitamin D and disease prevention with special reference to cardiovascular disease. Prog Biophys Mol Biol 2006;92:39-48.

2. Holick MF, et al. Vitamin D deficiency. N Engl J Med 2007;357:266-281.

3. Wang TJ, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008;117:503-511.

4. Lee JH, et al. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor? J Am Coll Cardiol 2008;52:1949-1956.

5. Martins D, et al. Prevalence of cardiovascular risk factors and the serum levels of vitamin D in the United States: Data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2007;167:1159-1165.

6. Lee JH, et al. Prevalence of vitamin D deficiency in patients with acute myocardial infarction. Am J Cardiol 2011;107:1636-1638.

7. Holick MF, et al. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004; 80:1678S-1688S.

8. Matsuoka LY, et al. Racial pigmentation and the cutaneous synthesis of vitamin D. Arch Dermatol 1991; 127:536-538.

9. Cigolinu M, et al. Serum vitamin D concentrations and prevalence of cardiovascular disease among type II diabetic patients. Diabetes Care 2006;29:722-724.

10. Lin E, et al. Contribution of adipose tissue to plasma 25-hydroxyvitamin D concentrations during weight loss following gastric bypass surgery. Obesity (Silver Spring) 2011;19:588-594.