Circulating 25OHD, Dietary Vitamin D, PTH, and Calcium Associations

with Incident Cardiovascular Disease and Mortality:

The MIDSPAN Family Study

The Journal of Clinical Endocrinology & Metabolism October 15, 2012 jc.2012-2272
Paul Welsh, Orla Doolin, Alex McConnachie, Emma Boulton, Geraldine McNeil, Helen Macdonald, Antonia Hardcastle, Carole Hart, Mark Upton, Graham Watt and Naveed Sattar
Institute of Cardiovascular and Medical Sciences (P.W., E.B., N.S.), Robertson Centre for Biostatistics (O.D., A.M.), Institute of Health and Wellbeing (C.H.), and General Practice and Primary Care (G.W.), University of Glasgow, Glasgow G12 8TA, United Kingdom; Public Health Nutrition Research Group (G.M., H.M., A.H.), University of Aberdeen, Aberdeen AB24 3FX, United Kingdom; and Woodlands Family Medical Centre (M.U.), Stockton-on-Tees TS18 1YE, United Kingdom
Address all correspondence and requests for reprints to: Dr. Paul Welsh or Professor Naveed Sattar, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, Scotland, United Kingdom G12 8TA. E-mail: paul.welsh at glasgow.ac.uk or naveed.sattar at glasgow.ac.uk.

Context: Observational studies relating circulating 25-hydroxyvitamin D (25OHD) and dietary vitamin D intake to cardiovascular disease (CVD) have reported conflicting results.

Objective: Our objective was to investigate the association of 25OHD, dietary vitamin D, PTH, and adjusted calcium with CVD and mortality in a Scottish cohort.

Design and Setting: The MIDSPAN Family Study is a prospective study of 1040 men and 1298 women from the West of Scotland recruited in 1996 and followed up for a median 14.4 yr.

Participants: Locally resident adult offspring of a general population cohort were recruited from 1972–1976.

Main Outcome Measures: CVD events (n = 416) and all-cause mortality (n = 100) were evaluated.

Results: 25OHD was measured using liquid chromatography-tandem mass spectrometry in available plasma (n = 2081).
Median plasma 25OHD was 18.6 ng/ml, and median vitamin D intake was 3.2 ?g/d (128 IU/d).
Vitamin D deficiency (25OHD <15 ng/ml) was present in 689 participants (33.1%).

There was no evidence that dietary vitamin D intake, PTH, or adjusted calcium were associated with CVD events or with mortality.

Vitamin D deficiency was not associated with CVD (fully adjusted hazard ratio = 1.00; 95% confidence interval = 0.77–1.31).
Results were similar after excluding patients who reported an activity-limiting longstanding illness at baseline (18.8%) and those taking any vitamin supplements (21.7%).

However, there was some evidence vitamin D deficiency was associated with all-cause mortality (fully adjusted hazard ratio = 2.02; 95% confidence interval = 1.17–3.51).

Conclusion: Vitamin D deficiency was not associated with risk of CVD in this cohort with very low 25OHD.
Future trials of vitamin D supplementation in middle-aged cohorts should be powered to detect differences in mortality outcomes as well as CVD.

Received May 22, 2012; Accepted September 21, 2012.
Copyright © 2012 by The Endocrine Society
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Summary by Vitamin D Life

• 2081 elderly? Scotts tracked for 14 years
• Vitamin D measured (once?) average 19 ng/ml, 33% had < 15 ng/ml
  {Guess that very few had > 30 ng}
• No association found between vitamin D levels and 416 cardiovascular events
• Those who had started with <15 ng/ml were 2X more likely to die. (out of 100)

See also Vitamin D Life

• Overview Cardiovascular and vitamin D
• All items in Mortality and vitamin D (not just Cardio) 207 items
• All items in Cardiovascular and Vitamin D 429 items
• Dr. Grant on vitamin D and mortality in Vitamin D Life - which includes the following chart

• Coronary Artery Disease predicted by low levels of vitamin D – April 2012
• Cardiovascular Disease and vitamin D - April 2012
• Death rate 2X higher if low vitamin D - 180,000 adults, not just elderly – May 2012
• Death rate reduced 8 % for 8 nanogram more vitamin D – meta-analysis Feb 2012
• Vitamin D decreases incidence of disease has the following chart which shows that heart attacks not decreased until 40 ng of vitamin D
  which is far higher than probably any of the Scotts in this study had

See also web

• Intervention Clinical Trials for (heart OR cardiovascular) and "vitamin D" 227 as of Oct 2012