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Serum 25-hydroxyvitamin D concentration and risk for major clinical disease events in a community-based population of older adults: a cohort study.
Tuesday,2012-11-06 12:26 America/Los_Angeles — eenright
| Title | Serum 25-hydroxyvitamin D concentration and risk for major clinical disease events in a community-based population of older adults: a cohort study. |
| Publication Type | Journal Article |
| Year of Publication | 2012 |
| Authors | de Boer, IH, Levin, G, Robinson-Cohen, C, Biggs, ML, Hoofnagle, AN, Siscovick, DS, Kestenbaum, B |
| Journal | Ann Intern Med |
| Volume | 156 |
| Issue | 9 |
| Pagination | 627-34 |
| Date Published | 2012 May 01 |
| ISSN | 1539-3704 |
| Keywords | Aged, Cause of Death, Female, Follow-Up Studies, Hip Fractures, Humans, Male, Myocardial Infarction, Neoplasms, Proportional Hazards Models, Risk Assessment, Risk Factors, Seasons, United States, Vitamin D, Vitamin D Deficiency |
| Abstract | <p><b>BACKGROUND: </b>Circulating concentrations of 25-hydroxyvitamin D [25-(OH)D] are used to define vitamin D deficiency. Current clinical 25-(OH)D targets based on associations with intermediate markers of bone metabolism may not reflect optimal levels for other chronic diseases and do not account for known seasonal variation in 25-(OH)D concentration.</p><p><b>OBJECTIVE: </b>To evaluate the relationship of 25-(OH)D concentration with the incidence of major clinical disease events that are pathophysiologically relevant to vitamin D.</p><p><b>DESIGN: </b>Cohort study.</p><p><b>SETTING: </b>The Cardiovascular Health Study conducted in 4 U.S. communities. Data from 1992 to 2006 were included in this analysis.</p><p><b>PARTICIPANTS: </b>1621 white older adults.</p><p><b>MEASUREMENTS: </b>Serum 25-(OH)D concentration (using a high-performance liquid chromatography-tandem mass spectrometry assay that conforms to National Institute of Standards and Technology reference standards) and associations with time to a composite outcome of incident hip fracture, myocardial infarction, cancer, or death.</p><p><b>RESULTS: </b>Over a median 11-year follow-up, the composite outcome occurred in 1018 participants (63%). Defining events included 137 hip fractures, 186 myocardial infarctions, 335 incidences of cancer, and 360 deaths. The association of low 25-(OH)D concentration with risk for the composite outcome varied by season (P = 0.057). A concentration lower than a season-specific Z score of -0.54 best discriminated risk for the composite outcome and was associated with a 24% higher risk in adjusted analyses (95% CI, 9% to 42%). Corresponding season-specific 25-(OH)D concentrations were 43, 50, 61, and 55 nmol/L (17, 20, 24, and 22 ng/mL) in winter, spring, summer, and autumn, respectively.</p><p><b>LIMITATION: </b>The observational study was restricted to white participants.</p><p><b>CONCLUSION: </b>Threshold concentrations of 25-(OH)D associated with increased risk for relevant clinical disease events center near 50 nmol/L (20 ng/mL). Season-specific targets for 25-(OH)D concentration may be more appropriate than static targets when evaluating health risk.</p><p><b>PRIMARY FUNDING SOURCE: </b>National Institutes of Health.</p> |
| DOI | 10.7326/0003-4819-156-9-201205010-00004 |
| Alternate Journal | Ann. Intern. Med. |
| PubMed ID | 22547472 |
| PubMed Central ID | PMC3632351 |
| Grant List | R01 DK088762 / DK / NIDDK NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States R01 AG015928 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States R01HL096875 / HL / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States AG-15928 / AG / NIA NIH HHS / United States R56 AG020098 / AG / NIA NIH HHS / United States R01HL084443 / HL / NHLBI NIH HHS / United States R01DK088762 / DK / NIDDK NIH HHS / United States AG-20098 / AG / NIA NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States AG-027058 / AG / NIA NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States N01 HC-55222 / HC / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States R01 HL080295 / HL / NHLBI NIH HHS / United States R01 HL084443 / HL / NHLBI NIH HHS / United States R01 AG020098 / AG / NIA NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States HL080295 / HL / NHLBI NIH HHS / United States N01-HC-85239 / HC / NHLBI NIH HHS / United States AG-023629 / AG / NIA NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States R01 AG027058 / AG / NIA NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States R01 HL096875 / HL / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States R56 AG023629 / AG / NIA NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States |