Vit D Deficiency and ACS & CAD – is there relation?

At the ACC.17 Scientific Session, study data found vitamin D to be an important risk factor for acute coronary syndrome (ACS) and severe coronary artery disease (CAD), including left main and triple vessel disease.

Study authors, led by Amar N. Patnaik, from Star Hospitals, Hyderabad, India, investigated whether low vitamin D concentrations were associated with ACS and if it could predict the severity of CAD. They conducted a prospective study of 320 patients aged 24–75 years undergoing coronary angiography for any chest pain syndrome. Patients’ blood samples were analyzed for vitamin D levels (25-OH-vitamin D) prior to the angiogram. Patients who had taken vitamin D supplements recently were not included in the study.

“Significant CAD was defined as at least 1 vessel showing diameter stenosis with >70%, while severe CAD [was] left main and/or triple vessel disease, as evaluated by coronary angiography,” Patnaik said.

Of the total patients, 86 (26.8%) presented with ACS with mean vitamin D levels of 16.7±8.7ng/mL.

Normal vitamin D levels (>30ng/mL) were seen in 37 patients (11.5%), vitamin D insufficiency (21–29ng/mL) in 104 (32.5%) patients, and vitamin D deficiency (<20ng/mL) in 179 (60%) patients. These corresponded to ACS in 7 (8.1%) patients with normal vitamin D levels, 26 (30.2%) patients with vitamin D insufficiency, and 53 (61.6%) patients with vitamin D deficiency. In addition, the values corresponded to CSA in 30 (12.8%) of patients with normal vitamin D levels, 78 (33.3%) patients with vitamin D insufficiency, and 126 (53.8%) in patients with vitamin D deficiency.

“In those with normal vitamin [D] levels, 7 (18.9%) presented with ACS,” explained Patnaik. ACS was seen in 26 (25%) patients with vitamin D insufficiency and in 53 (29.6%) patients with vitamin D deficiency. Additional analysis found severe vitamin D deficiency (<10ng/mL) was associated with ST-elevation myocardial infarction (STEMI; P=0.001).

A linear correlation between vitamin D deficiency and severe CAD was seen (P=0.01) through an extended Mantel-Haenszel Chi-square trend an analysis. Bigger studies in the future are needed, however, for more definitive conclusions on whether vitamin D deficiency is a major risk factor for ACS and severe CAD.

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