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Prevalence of Hypovitaminosis D in Cardiovascular Diseases (from the National Health and Nutrition Examination Survey 2001 to 2004)

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This cross-sectional study examined the burden of cardiovascular diseases (CVDs) using serum 25-hydroxyvitamin D (25[OH]D) and prevalence of hypovitaminosis D in adults with CVDs using data from NHANES 2001 to 2004. Serum 25(OH)D levels were divided into 3 categories (≥30, 20 to 29, and <20 ng/ml), and hypovitaminosis D was defined as vitamin D <30 ng/ml. Of 8,351 adults who had 25(OH)D measured, mean 25(OH)D was 24.3 ng/ml, and the prevalence of hypovitaminosis D was 74%. The burden of CVDs increased with lower 25(OH)D categories, with 5.3%, 6.7%, and 7.3% coronary heart disease; 1.5%, 2.4%, and 3.2% heart failure; 2.5%, 2.0%, and 3.2% stroke; and 3.6%, 5.0%, and 7.7% peripheral arterial disease. Across all CVDs, hypovitaminosis D was more common in blacks than Hispanics or whites. Compared with persons at low risk for CVDs (68%), it was more prevalent in those at high risk (75%; odds ratio [OR] 1.32, 95% confidence interval [CI] 1.05 to 1.67), with coronary heart disease (77%; OR 1.48, 95% CI 1.14 to 1.91), and both coronary heart disease and heart failure (89%; OR 3.52, 95% CI 1.58 to 7.84) after controlling for age, race, and gender. In conclusion, hypovitaminosis D was highly prevalent in US adults with CVDs, particularly those with both coronary heart disease and heart failure.

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Methods

NHANES is a nationally representative survey of the noninstitutionalized population in the United States.9 It used a complex multistage cluster design to estimate the prevalence of chronic conditions. For this study, we combined the 2001 to 2004 cycles of NHANES for adequate sample size. This study was approved by the institutional review board at Thomas Jefferson University. Of 9,145 subjects ≥20 years who had serum 25(OH)D measured, races other than white, black, and Hispanic (n = 346) and

Results

Mean 25(OH)D was 24.3 ng/ml (61 nmol/L). The level decreased with older age (24.4 for 20 to 64 years, 24.3 for 65 to 74 years, and 23.6 for ≥75 years; p = 0.001) and black and Hispanic race (26.2 for white, 14.9 for black, and 21.2 for Hispanic; p <0.001), but did not differ by gender (24.6 for men and 24.0 for women; p = 0.115). Table 1 lists mean 25(OH)D by lifestyle and clinical characteristics. The burden of CVDs except stroke increased with lower 25(OH)D (Figure 1). The strength of

Discussion

In NHANES 2001 to 2004, CVDs were more prevalent in adults with lower 25(OH)D, and hypovitaminosis D was also more common in those with certain CVDs. Although our findings were consistent with previous reports of the association of hypovitaminosis D with cardiovascular risk factors5 and such CVDs as coronary heart disease,7 heart failure,8 stroke,6 and peripheral arterial disease,5 our study provided national data about the burden of CVDs by 25(OH)D levels and the prevalence of hypovitaminosis

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