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Vitamin D Deficiency, Inflammation, and Diminished Endogenous Regenerative Capacity in Coronary Heart Disease.
Desai, Shivang R; Ko, Yi-An; Liu, Chang; Hafeez, Zaki; Park, Jiwon; Faaborg-Andersen, Christian; Alvi, Zain; Alras, Zahran; Alkhoder, Ayman A; Martini, Afif; Varughese, Anil; Ejaz, Kiran; Cheung, Brian; Wang, Maggie; Gold, Daniel A; Gold, Matthew E; Jain, Vardhmaan; Vatsa, Nishant; Islam, Shabatun J; Almuwaqqat, Zakaria; Dhindsa, Devinder S; Mehta, Anurag; Kim, Jonathan H; Wilson, Peter; Waller, Edmund K; Vaccarino, Viola; Quyyumi, Arshed A.
Afiliação
  • Desai SR; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Ko YA; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Liu C; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
  • Hafeez Z; Indiana University School of Medicine, Indianapolis, Indiana, USA.
  • Park J; Emory University, Atlanta, Georgia, USA.
  • Faaborg-Andersen C; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Alvi Z; Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Alras Z; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Alkhoder AA; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Martini A; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Varughese A; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Ejaz K; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Cheung B; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Wang M; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Gold DA; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Gold ME; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Jain V; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Vatsa N; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Islam SJ; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Almuwaqqat Z; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Dhindsa DS; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Mehta A; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Kim JH; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Wilson P; VCU Health Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
  • Waller EK; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Vaccarino V; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Quyyumi AA; Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
JACC Adv ; 3(2): 100804, 2024 Feb.
Article em En | MEDLINE | ID: mdl-38939377
ABSTRACT

Background:

Vitamin D deficiency (VDD) is associated with coronary heart disease (CHD) and poor outcomes, but supplementation does not improve prognosis. VDD has been implicated in and may promote greater risk through inflammation and impaired progenitor cell function.

Objectives:

The authors examined VDD, high-sensitivity C-reactive protein (hsCRP), circulating progenitor cell (CPC) counts, and outcomes in patients with CHD. They hypothesized that the higher risk with VDD is mediated by inflammation and impaired regenerative capacity.

Methods:

A total of 5,452 individuals with CHD in the Emory Cardiovascular Biobank had measurement of 25-hydroxyvitamin D, subsets of whom had hsCRP measurements and CPCs estimated as CD34-expressing mononuclear cell counts. Findings were validated in an independent cohort. 25-hydroxyvitamin D <20 ng/mL was considered VDD. Cox and Fine-Gray models determined associations between marker levels and 1) all-cause mortality; 2) cardiovascular mortality; and 3) major adverse cardiovascular events, a composite of adverse CHD outcomes.

Results:

VDD (43.6% of individuals) was associated with higher adjusted cardiovascular mortality (HR 1.57, 95% CI 1.09-2.28). There were significant interactions between VDD and hsCRP and CPC counts in predicting cardiovascular mortality. Individuals with both VDD and elevated hsCRP had the greatest risk (HR 2.82, 95% CI 2.16-3.67). Only individuals with both VDD and low CPC counts were at high risk (HR 2.25, 95% CI 1.46-3.46). These findings were reproduced in the validation cohort.

Conclusions:

VDD predicts adverse outcomes in CHD. Those with VDD, inflammation and/or diminished regenerative capacity are at a significantly greater risk of cardiovascular mortality. Whether targeted supplementation in these high-risk groups improves risk warrants further study.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article