Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients
Identifieur interne : 000D48 ( Main/Exploration ); précédent : 000D47; suivant : 000D49Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients
Auteurs : Christiane Drechsler [Allemagne, Pays-Bas, Niger] ; Stefan Pilz [Autriche] ; Barbara Obermayer-Pietsch [Autriche] ; Marion Verduijn [Pays-Bas] ; Andreas Tomaschitz [Autriche] ; Vera Krane [Allemagne] ; Katharina Espe [Allemagne] ; Friedo Dekker [Pays-Bas] ; Vincent Brandenburg [Allemagne] ; Winfried Mrz [Allemagne, Autriche] ; Eberhard Ritz [Allemagne] ; Christoph Wanner [Allemagne]Source :
- European Heart Journal [ 0195-668X ] ; 2010-09.
Abstract
Aims Dialysis patients experience an excess mortality, predominantly of sudden cardiac death (SCD). Accumulating evidence suggests a role of vitamin D for myocardial and overall health. This study investigated the impact of vitamin D status on cardiovascular outcomes and fatal infections in haemodialysis patients. Methods and results 25-hydroxyvitamin D [25(OH)D] was measured in 1108 diabetic haemodialysis patients who participated in the German Diabetes and Dialysis Study and were followed up for a median of 4 years. By Cox regression analyses, we determined hazard ratios (HR) for pre-specified, adjudicated endpoints according to baseline 25(OH)D levels: SCD (n 146), myocardial infarction (MI, n 174), stroke (n 89), cardiovascular events (CVE, n 414), death due to heart failure (n 37), fatal infection (n 111), and all-cause mortality (n 545). Patients had a mean age of 66 8 years (54 male) and median 25(OH)D of 39 nmol/L (interquartile range: 2855). Patients with severe vitamin D deficiency [25(OH)D of 25 nmol/L] had a 3-fold higher risk of SCD compared with those with sufficient 25(OH)D levels >75 nmol/L [HR: 2.99, 95 confidence interval (CI): 1.396.40]. Furthermore, CVE and all-cause mortality were strongly increased (HR: 1.78, 95 CI: 1.182.69, and HR: 1.74, 95 CI: 1.222.47, respectively), all persisting in multivariate models. There were borderline non-significant associations with stroke and fatal infection while MI and deaths due to heart failure were not meaningfully affected. Conclusion Severe vitamin D deficiency was strongly associated with SCD, CVE, and mortality, and there were borderline associations with stroke and fatal infection. Whether vitamin D supplementation decreases adverse outcomes requires further evaluation.
Url:
DOI: 10.1093/eurheartj/ehq246
Affiliations:
- Allemagne, Autriche, Niger, Pays-Bas
- Bade-Wurtemberg, Bavière, District de Basse-Franconie, District de Cologne, District de Karlsruhe, Hollande-Méridionale, Rhénanie-du-Nord-Westphalie
- Aix-la-Chapelle, Heidelberg, Leyde, Wurtzbourg
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first="Marion" last="Verduijn">Marion Verduijn</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Clinical Epidemiology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Tomaschitz, Andreas" sort="Tomaschitz, Andreas" uniqKey="Tomaschitz A" first="Andreas" last="Tomaschitz">Andreas Tomaschitz</name><affiliation wicri:level="1"><country xml:lang="fr">Autriche</country><wicri:regionArea>Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz</wicri:regionArea><wicri:noRegion>Graz</wicri:noRegion></affiliation></author><author><name sortKey="Krane, Vera" sort="Krane, Vera" uniqKey="Krane V" first="Vera" last="Krane">Vera Krane</name><affiliation wicri:level="3"><country 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nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Wanner, Christoph" sort="Wanner, Christoph" uniqKey="Wanner C" first="Christoph" last="Wanner">Christoph Wanner</name><affiliation wicri:level="3"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Internal Medicine 1, Division of Nephrology, University of Wrzburg, Oberdrrbacher Str. 6, D-97080 Wrzburg</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Basse-Franconie</region><settlement type="city">Wurtzbourg</settlement></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-09">2010-09</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">18</biblScope><biblScope unit="page" from="2253">2253</biblScope><biblScope unit="page" to="2261">2261</biblScope></imprint><idno type="ISSN">0195-668X</idno></series><idno type="istex">94DE17115CB26C3B3A6F159054F520B5CB3FC156</idno><idno type="DOI">10.1093/eurheartj/ehq246</idno><idno type="ArticleID">ehq246</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Aims Dialysis patients experience an excess mortality, predominantly of sudden cardiac death (SCD). Accumulating evidence suggests a role of vitamin D for myocardial and overall health. This study investigated the impact of vitamin D status on cardiovascular outcomes and fatal infections in haemodialysis patients. Methods and results 25-hydroxyvitamin D [25(OH)D] was measured in 1108 diabetic haemodialysis patients who participated in the German Diabetes and Dialysis Study and were followed up for a median of 4 years. By Cox regression analyses, we determined hazard ratios (HR) for pre-specified, adjudicated endpoints according to baseline 25(OH)D levels: SCD (n 146), myocardial infarction (MI, n 174), stroke (n 89), cardiovascular events (CVE, n 414), death due to heart failure (n 37), fatal infection (n 111), and all-cause mortality (n 545). Patients had a mean age of 66 8 years (54 male) and median 25(OH)D of 39 nmol/L (interquartile range: 2855). Patients with severe vitamin D deficiency [25(OH)D of 25 nmol/L] had a 3-fold higher risk of SCD compared with those with sufficient 25(OH)D levels >75 nmol/L [HR: 2.99, 95 confidence interval (CI): 1.396.40]. Furthermore, CVE and all-cause mortality were strongly increased (HR: 1.78, 95 CI: 1.182.69, and HR: 1.74, 95 CI: 1.222.47, respectively), all persisting in multivariate models. There were borderline non-significant associations with stroke and fatal infection while MI and deaths due to heart failure were not meaningfully affected. Conclusion Severe vitamin D deficiency was strongly associated with SCD, CVE, and mortality, and there were borderline associations with stroke and fatal infection. Whether vitamin D supplementation decreases adverse outcomes requires further evaluation.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Autriche</li><li>Niger</li><li>Pays-Bas</li></country><region><li>Bade-Wurtemberg</li><li>Bavière</li><li>District de Basse-Franconie</li><li>District de Cologne</li><li>District de Karlsruhe</li><li>Hollande-Méridionale</li><li>Rhénanie-du-Nord-Westphalie</li></region><settlement><li>Aix-la-Chapelle</li><li>Heidelberg</li><li>Leyde</li><li>Wurtzbourg</li></settlement></list><tree><country name="Allemagne"><region name="Bavière"><name sortKey="Drechsler, Christiane" sort="Drechsler, Christiane" uniqKey="Drechsler C" first="Christiane" last="Drechsler">Christiane Drechsler</name></region><name sortKey="Brandenburg, Vincent" sort="Brandenburg, Vincent" uniqKey="Brandenburg V" first="Vincent" last="Brandenburg">Vincent Brandenburg</name><name sortKey="Espe, Katharina" sort="Espe, Katharina" uniqKey="Espe K" first="Katharina" last="Espe">Katharina Espe</name><name sortKey="Krane, Vera" sort="Krane, Vera" uniqKey="Krane V" first="Vera" last="Krane">Vera Krane</name><name sortKey="Mrz, Winfried" sort="Mrz, Winfried" uniqKey="Mrz W" first="Winfried" last="Mrz">Winfried Mrz</name><name sortKey="Ritz, Eberhard" sort="Ritz, Eberhard" uniqKey="Ritz E" first="Eberhard" last="Ritz">Eberhard Ritz</name><name sortKey="Wanner, Christoph" sort="Wanner, Christoph" uniqKey="Wanner C" first="Christoph" last="Wanner">Christoph Wanner</name></country><country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Drechsler, Christiane" sort="Drechsler, Christiane" uniqKey="Drechsler C" first="Christiane" last="Drechsler">Christiane Drechsler</name></region><name sortKey="Dekker, Friedo" sort="Dekker, Friedo" uniqKey="Dekker F" first="Friedo" last="Dekker">Friedo Dekker</name><name sortKey="Verduijn, Marion" sort="Verduijn, Marion" uniqKey="Verduijn M" first="Marion" last="Verduijn">Marion Verduijn</name></country><country name="Niger"><noRegion><name sortKey="Drechsler, Christiane" sort="Drechsler, Christiane" uniqKey="Drechsler C" first="Christiane" last="Drechsler">Christiane Drechsler</name></noRegion></country><country name="Autriche"><noRegion><name sortKey="Pilz, Stefan" sort="Pilz, Stefan" uniqKey="Pilz S" first="Stefan" last="Pilz">Stefan Pilz</name></noRegion><name sortKey="Mrz, Winfried" sort="Mrz, Winfried" uniqKey="Mrz W" first="Winfried" last="Mrz">Winfried Mrz</name><name sortKey="Obermayer Pietsch, Barbara" sort="Obermayer Pietsch, Barbara" uniqKey="Obermayer Pietsch B" first="Barbara" last="Obermayer-Pietsch">Barbara Obermayer-Pietsch</name><name sortKey="Tomaschitz, Andreas" sort="Tomaschitz, Andreas" uniqKey="Tomaschitz A" first="Andreas" last="Tomaschitz">Andreas Tomaschitz</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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