Link of low vitamin D with coronary heart disease varies by race

Image: PD

1. Low serum 25-hydroxy vitamin D (25(OH)D) levels were associated with coronary heart disease events in Caucasians and Chinese participants. 

2. Low serum 25-hydroxy vitamin D (25(OH)D) levels were not associated with coronary heart disease events in Black or Hispanic participants. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Previous studies have examined the relationship between serum 25(OH)D and coronary heart disease (CHD) risk and have shown that lower serum levels are associated with a higher risk. However, many of these studies have included a largely homogenous cohort of Caucasian participants. Therefore, application of these results to multicultural population is limited. This current study has demonstrated that the relationship between low serum 25(OH)D levels and CHD exists in Caucasian and Chinese populations but not in Black or Hispanic groups. Drawbacks of this study include, firstly, that serum 25(OH)D levels were only measured at the start of the study and not followed longitudinally to correlate 25(OH)D levels at the onset of CHD. Secondly, all data regarding CHD was self reported, potentially leading to a self-reporting bias. Ultimately, the major strength of this study is that it is the first to analyze 25(OH)D levels in a multiethnic cohort. Furthermore, additional studies are needed to elucidate the mechanism by which 25(OH)D levels vary among ethnic groups in order to target vitamin D therapy within these cohorts.

Click to read the study, published today in JAMA

Click to read an accompanying editorial, published today in JAMA

Relevant Reading: Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies

In-Depth [prospective cohort study]: This study utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA), a multi-center, prospective cohort study.  Serum 25(OH)D values from 6,436 participants were measured at the onset of the MESA study, and were found to be heterogeneous between races. Follow up was conducted via a telephone interview with each participant every 9-12 months for 8.5 years to inquire about hospital admissions, cardiovascular diagnoses, and death.  During follow up, 139 participants had myocardial infarctions, 14 had resuscitated cardiac arrest, 163 developed angina, and 46 had died. Serum 25(OH) D concentration was associated with significantly higher risk of CHD among Caucasian participants and Chinese participants (HR 1.26 95% CI 1.06-1.49 versus 1.67 95% CI 1.07-2.61, respectively).  However, there was no evidence of association in Black or Hispanic participants (HR 0.93 95% CI 0.73-1.20 versus 1.01 95% CI 0.77-1.33, respectively).

By Jeffrey Cohen and Brittany Hasty

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