Circulating 25-hydroxy-vitamin D and the risk of cardiovascular diseases. Systematic review and meta-analysis of prospective cohort studies

Rati Jani; Kshemina Mhaskar; Thomas Tsiampalis; Nigussie A. Kassaw; A. M. Gonzalez; Demosthenes B.  Panagiotakos

doi:10.1016/j.numecd.2021.09.003

Circulating 25-hydroxy-vitamin D and the risk of cardiovascular diseases. Systematic review and meta-analysis of prospective cohort studies

Rati Jani
, Kshemina Mhaskar
, Thomas Tsiampalis
, Nigussie A. Kassaw
, A. M. Gonzalez
, Demosthenes B. Panagiotakos

Research output: Contribution to journal › Article › peer-review

28 Citations (Scopus)

Abstract

Aims
Circulating vitamin D is linked with the risk of cardiovascular disease (CVD). A meta-analysis has yet to explicitly explore correlation between vitamin D and the risk of CVD incidence and recurrent CVD. This meta-analysis examines the association between 25-hydroxy-vitamin D (25(OH)D) and the risk of CVD incidence (fatal, non-fatal, fatal and non-fatal combined events) and the risk of recurrent CVD (fatal, recurrent, and fatal and recurrent combined events). PROSPERO registration-CRD42021251483.

Data synthesis
A total of 79 studies (46 713 CVD cases in 1 397 831 participants) were included in the meta-analysis, of which 61 studies examined the risk of CVD incidence events, and 18 studies examined risk of recurrent CVD events. The risk of CVD incidence events (RR = 1.34, 95% CI: 1.26–1.43, p < 0.001) and recurrent CVD events (RR = 1.86, 95% CI: 1.46–2.36, p < 0.001) was higher in the lowest than the highest category of circulating 25(OH)D. Dose–response analysis reported a linear association for every 10 ng/ml increment of 25(OH)D and non-fatal CVD incidence events (RR = 0.94; 95% CI = 0.89–0.98, p = 0.005), lower fatal recurrent CVD events (RR = 0.45; 95% CI = 0.32–0.62, p < 0.001) and lower combined recurrent CVD events (RR = 0.80; 95% CI = 0.65–0.97, p = 0.023). A non-linear association was observed between higher 25(OH)D and lower fatal CVD incidence events (P-nonlinear<0.001), lower combined CVD incidence events (P-nonlinear = 0.001), and lower non-fatal recurrent CVD events (P-nonlinear = 0.044).

Conclusions
The lowest category of circulating 25(OH)D was associated with a higher risk of CVD incidence events and recurrent CVD events.

Original language	English
Pages (from-to)	3282-3304
Number of pages	23
Journal	Nutrition, Metabolism and Cardiovascular Diseases
Volume	31
Issue number	12
DOIs	https://doi.org/10.1016/j.numecd.2021.09.003
Publication status	Published - 29 Nov 2021

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1016/j.numecd.2021.09.003

Cite this

@article{7032f4d75f344afc99b841462d2f91b4,

title = "Circulating 25-hydroxy-vitamin D and the risk of cardiovascular diseases. Systematic review and meta-analysis of prospective cohort studies",

abstract = "Aims Circulating vitamin D is linked with the risk of cardiovascular disease (CVD). A meta-analysis has yet to explicitly explore correlation between vitamin D and the risk of CVD incidence and recurrent CVD. This meta-analysis examines the association between 25-hydroxy-vitamin D (25(OH)D) and the risk of CVD incidence (fatal, non-fatal, fatal and non-fatal combined events) and the risk of recurrent CVD (fatal, recurrent, and fatal and recurrent combined events). PROSPERO registration-CRD42021251483. Data synthesis A total of 79 studies (46 713 CVD cases in 1 397 831 participants) were included in the meta-analysis, of which 61 studies examined the risk of CVD incidence events, and 18 studies examined risk of recurrent CVD events. The risk of CVD incidence events (RR = 1.34, 95\% CI: 1.26–1.43, p < 0.001) and recurrent CVD events (RR = 1.86, 95\% CI: 1.46–2.36, p < 0.001) was higher in the lowest than the highest category of circulating 25(OH)D. Dose–response analysis reported a linear association for every 10 ng/ml increment of 25(OH)D and non-fatal CVD incidence events (RR = 0.94; 95\% CI = 0.89–0.98, p = 0.005), lower fatal recurrent CVD events (RR = 0.45; 95\% CI = 0.32–0.62, p < 0.001) and lower combined recurrent CVD events (RR = 0.80; 95\% CI = 0.65–0.97, p = 0.023). A non-linear association was observed between higher 25(OH)D and lower fatal CVD incidence events (P-nonlinear<0.001), lower combined CVD incidence events (P-nonlinear = 0.001), and lower non-fatal recurrent CVD events (P-nonlinear = 0.044). Conclusions The lowest category of circulating 25(OH)D was associated with a higher risk of CVD incidence events and recurrent CVD events.",

keywords = "Cardiovascular disease, Fatal, Incidence, Non-fatal, Vitamin D",

author = "Rati Jani and Kshemina Mhaskar and Thomas Tsiampalis and Kassaw, \{Nigussie A.\} and Gonzalez, \{A. M.\} and Panagiotakos, \{Demosthenes B.\}",

note = "Funding Information: The association between circulating 25(OH)D and the risk of CVD events was examined in both healthy populations (hereafter referred to as the risk of CVD incidence events) and patients with previous CVD (hereafter referred to as the risk of recurrent CVD events); therefore, the inclusion criteria varied slightly. Common criteria included the inclusion of prospective cohort studies. The longitudinal nature of prospective cohort design supports examining the association of circulating 25(OH)D with CVD events in naturalised settings [21]. Studies published in English after the year 2000 were chosen because methods to measure circulating 25(OH)D varied for those published before the year 2000 [12]. Studies that examined serum or plasma 25(OH)D as the exposure variable were included as it is a standard marker and the primary form of circulating 25(OH)D [13]. Studies that specified baseline serum or plasma 25(OH)D cut-offs and provided Hazard ratio (HR) or Odds Ratio (OR) or Risk Ratio (RR) with 95\% Confidence Interval (95\% CI) were included. When multiple studies were published on the same participant cohort, the publication with the largest sample size and/or more complete data set were selected for reporting the combined estimates [22]. Publisher Copyright: {\textcopyright} 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University",

year = "2021",

month = nov,

day = "29",

doi = "10.1016/j.numecd.2021.09.003",

language = "English",

volume = "31",

pages = "3282--3304",

journal = "Nutrition, Metabolism and Cardiovascular Diseases",

issn = "0939-4753",

publisher = "Elsevier",

number = "12",

}

TY - JOUR

T1 - Circulating 25-hydroxy-vitamin D and the risk of cardiovascular diseases. Systematic review and meta-analysis of prospective cohort studies

AU - Jani, Rati

AU - Mhaskar, Kshemina

AU - Tsiampalis, Thomas

AU - Kassaw, Nigussie A.

AU - Gonzalez, A. M.

AU - Panagiotakos, Demosthenes B.

N1 - Funding Information: The association between circulating 25(OH)D and the risk of CVD events was examined in both healthy populations (hereafter referred to as the risk of CVD incidence events) and patients with previous CVD (hereafter referred to as the risk of recurrent CVD events); therefore, the inclusion criteria varied slightly. Common criteria included the inclusion of prospective cohort studies. The longitudinal nature of prospective cohort design supports examining the association of circulating 25(OH)D with CVD events in naturalised settings [21]. Studies published in English after the year 2000 were chosen because methods to measure circulating 25(OH)D varied for those published before the year 2000 [12]. Studies that examined serum or plasma 25(OH)D as the exposure variable were included as it is a standard marker and the primary form of circulating 25(OH)D [13]. Studies that specified baseline serum or plasma 25(OH)D cut-offs and provided Hazard ratio (HR) or Odds Ratio (OR) or Risk Ratio (RR) with 95% Confidence Interval (95% CI) were included. When multiple studies were published on the same participant cohort, the publication with the largest sample size and/or more complete data set were selected for reporting the combined estimates [22]. Publisher Copyright: © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University

PY - 2021/11/29

Y1 - 2021/11/29

N2 - Aims Circulating vitamin D is linked with the risk of cardiovascular disease (CVD). A meta-analysis has yet to explicitly explore correlation between vitamin D and the risk of CVD incidence and recurrent CVD. This meta-analysis examines the association between 25-hydroxy-vitamin D (25(OH)D) and the risk of CVD incidence (fatal, non-fatal, fatal and non-fatal combined events) and the risk of recurrent CVD (fatal, recurrent, and fatal and recurrent combined events). PROSPERO registration-CRD42021251483. Data synthesis A total of 79 studies (46 713 CVD cases in 1 397 831 participants) were included in the meta-analysis, of which 61 studies examined the risk of CVD incidence events, and 18 studies examined risk of recurrent CVD events. The risk of CVD incidence events (RR = 1.34, 95% CI: 1.26–1.43, p < 0.001) and recurrent CVD events (RR = 1.86, 95% CI: 1.46–2.36, p < 0.001) was higher in the lowest than the highest category of circulating 25(OH)D. Dose–response analysis reported a linear association for every 10 ng/ml increment of 25(OH)D and non-fatal CVD incidence events (RR = 0.94; 95% CI = 0.89–0.98, p = 0.005), lower fatal recurrent CVD events (RR = 0.45; 95% CI = 0.32–0.62, p < 0.001) and lower combined recurrent CVD events (RR = 0.80; 95% CI = 0.65–0.97, p = 0.023). A non-linear association was observed between higher 25(OH)D and lower fatal CVD incidence events (P-nonlinear<0.001), lower combined CVD incidence events (P-nonlinear = 0.001), and lower non-fatal recurrent CVD events (P-nonlinear = 0.044). Conclusions The lowest category of circulating 25(OH)D was associated with a higher risk of CVD incidence events and recurrent CVD events.

AB - Aims Circulating vitamin D is linked with the risk of cardiovascular disease (CVD). A meta-analysis has yet to explicitly explore correlation between vitamin D and the risk of CVD incidence and recurrent CVD. This meta-analysis examines the association between 25-hydroxy-vitamin D (25(OH)D) and the risk of CVD incidence (fatal, non-fatal, fatal and non-fatal combined events) and the risk of recurrent CVD (fatal, recurrent, and fatal and recurrent combined events). PROSPERO registration-CRD42021251483. Data synthesis A total of 79 studies (46 713 CVD cases in 1 397 831 participants) were included in the meta-analysis, of which 61 studies examined the risk of CVD incidence events, and 18 studies examined risk of recurrent CVD events. The risk of CVD incidence events (RR = 1.34, 95% CI: 1.26–1.43, p < 0.001) and recurrent CVD events (RR = 1.86, 95% CI: 1.46–2.36, p < 0.001) was higher in the lowest than the highest category of circulating 25(OH)D. Dose–response analysis reported a linear association for every 10 ng/ml increment of 25(OH)D and non-fatal CVD incidence events (RR = 0.94; 95% CI = 0.89–0.98, p = 0.005), lower fatal recurrent CVD events (RR = 0.45; 95% CI = 0.32–0.62, p < 0.001) and lower combined recurrent CVD events (RR = 0.80; 95% CI = 0.65–0.97, p = 0.023). A non-linear association was observed between higher 25(OH)D and lower fatal CVD incidence events (P-nonlinear<0.001), lower combined CVD incidence events (P-nonlinear = 0.001), and lower non-fatal recurrent CVD events (P-nonlinear = 0.044). Conclusions The lowest category of circulating 25(OH)D was associated with a higher risk of CVD incidence events and recurrent CVD events.

KW - Cardiovascular disease

KW - Fatal

KW - Incidence

KW - Non-fatal

KW - Vitamin D

UR - https://www.scopus.com/pages/publications/85117165570

U2 - 10.1016/j.numecd.2021.09.003

DO - 10.1016/j.numecd.2021.09.003

M3 - Article

SN - 0939-4753

VL - 31

SP - 3282

EP - 3304

JO - Nutrition, Metabolism and Cardiovascular Diseases

JF - Nutrition, Metabolism and Cardiovascular Diseases

IS - 12

ER -

Circulating 25-hydroxy-vitamin D and the risk of cardiovascular diseases. Systematic review and meta-analysis of prospective cohort studies

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