Impact of Vitamin D deficiency on subclinical carotid atherosclerosis: a pooled analysis of cohort studies

Roberta Lupoli; Andrea Vaccaro; Pasquale Ambrosino; Paolo Poggio; Manuela Amato; Matteo Nicola Dario Di Minno

doi:10.1210/jc.2017-00342

Impact of Vitamin D deficiency on subclinical carotid atherosclerosis: a pooled analysis of cohort studies

J Clin Endocrinol Metab. 2017 Jul;102(7):2146-2153. doi: 10.1210/jc.2017-00342. Epub 2017 May 9.

Authors

Roberta Lupoli¹, Andrea Vaccaro¹, Pasquale Ambrosino¹, Paolo Poggio², Manuela Amato², Matteo Nicola Dario Di Minno³

Affiliations

¹ Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
² Centro Cardiologico Monzino, IRCCS, Milan, Italy
³ Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy

PMID: 28609831
DOI: 10.1210/jc.2017-00342

Abstract

Context: Vitamin D deficiency patients have an increased cardiovascular (CV) morbidity and mortality. Carotid intima-media thickness (IMT) and carotid plaques are markers of subclinical atherosclerosis and predictors of CV events.

Objective: To perform a meta-analysis of studies evaluating the impact of Vitamin D deficiency on common carotid artery IMT (CCA-IMT) and on the prevalence of carotid plaques.

Data sources: Studies were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases.

Results: Twenty-one studies (3,777 Vitamin D deficiency patients and 4,792 controls) with data on CCA-IMT and 6 studies (1,889 Vitamin D deficiency patients and 2,883 controls) on the prevalence of carotid plaques were included. Compared to controls, Vitamin D deficiency patients showed a significantly higher CCA-IMT (mean difference [MD]: 0.043 mm; 95%CI: 0.030, 0.056; P<0.001), and an increased prevalence of carotid plaques (Odds Ratio [OR]: 2.29, 95%CI: 1.03-5.11; P=0.043) with an attributable risk of 35.9%. When selecting studies specifically including patients with diabetes, the prevalence of carotid plaques in Vitamin D deficiency patients than in controls resulted higher (OR: 3.27; 95%CI: 1,62-6.62; P=0.001). A significant difference in CCA-IMT was confirmed when comparing patients with Vitamin D insufficiency to controls (MD: 0.011; 95%CI: 0.010-0.012, P<0.001). Sensitivity analyses substantially confirmed results and regression models showed that with the exception of LDL-cholesterol, HDL-cholesterol, triglycerides and the prevalence of hypercholesterolemia, all the other clinical and demographic co-variates significantly impacted on the difference in CCA-IMT between Vitamin D deficiency patients and controls.

Conclusions: Both Vitamin D deficiency and Vitamin D insufficiency are associated with subclinical atherosclerosis, potentially suggesting an increased CV risk in these clinical settings.

Keywords: atherosclerosis; ldl cholesterol lipoproteins; high density lipoprotein cholesterol; triglycerides; hypercholesterolemia; diabetes mellitus; vitamin d deficiency; cardiovascular disease risk factors; carotid atherosclerosis; diabetes mellitus, type 2; cardiovascular system; carotid artery, common; demography; morbidity; mortality; cardiovascular event; attributable; sensitivity analysis; carotid intima-media thickness; embase.