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Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: A 20-year study of a community-based cohort.
Clin Endocrinol (Oxf). 2018 Jan; 88(1):154-163.CE

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.

Authors+Show Affiliations

Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia.School of Population and Global Health, University of Western Australia, Crawley, WA, Australia.School of Population and Global Health, University of Western Australia, Crawley, WA, Australia.School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia.Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia.Department of Clinical Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia.Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28949411

Citation

Zhu, Kun, et al. "Serum 25-hydroxyvitamin D as a Predictor of Mortality and Cardiovascular Events: a 20-year Study of a Community-based Cohort." Clinical Endocrinology, vol. 88, no. 1, 2018, pp. 154-163.
Zhu K, Knuiman M, Divitini M, et al. Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: A 20-year study of a community-based cohort. Clin Endocrinol (Oxf). 2018;88(1):154-163.
Zhu, K., Knuiman, M., Divitini, M., Hung, J., Lim, E. M., Cooke, B. R., & Walsh, J. P. (2018). Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: A 20-year study of a community-based cohort. Clinical Endocrinology, 88(1), 154-163. https://doi.org/10.1111/cen.13485
Zhu K, et al. Serum 25-hydroxyvitamin D as a Predictor of Mortality and Cardiovascular Events: a 20-year Study of a Community-based Cohort. Clin Endocrinol (Oxf). 2018;88(1):154-163. PubMed PMID: 28949411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: 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, Y1 - 2017/10/09/ PY - 2017/07/07/received PY - 2017/09/18/revised PY - 2017/09/21/accepted PY - 2017/9/28/pubmed PY - 2018/8/16/medline PY - 2017/9/27/entrez KW - Australia KW - cardiovascular disease KW - follow-up study KW - health survey KW - heart failure KW - mortality KW - vitamin D SP - 154 EP - 163 JF - Clinical endocrinology JO - Clin Endocrinol (Oxf) VL - 88 IS - 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. SN - 1365-2265 UR - https://www.unboundmedicine.com/medline/citation/28949411/Serum_25_hydroxyvitamin_D_as_a_predictor_of_mortality_and_cardiovascular_events:_A_20_year_study_of_a_community_based_cohort_ L2 - https://doi.org/10.1111/cen.13485 DB - PRIME DP - Unbound Medicine ER -