CONGRESS ABSTRACT

Background: Suboptimal levels of vitamin D have been associated with imbalanced calcium homeostasis, impaired glucose and lipid metabolism, increased oxidative stress, inflammatory state and endothelial dysfunction. Despite a growing prevalence of hypovitaminosis D affecting all age groups and mostly female gender (defined as vitamin D levels < 20 ng/ml), our knowledge about the relationship between vitamin D levels and the severity of coronary artery disease (CAD) between genders remains limited. Aim and methods: In order to study the gender variations in hypovitaminosis D levels and the severity of CAD in individuals suffering from acute myocardial infarction (AMI), blood samples were obtained on hospital admission from patients with AMI enrolled from 2014 to 2022. CAD was defined as the presence of at least one coronary vessel stenosis greater than 50%, while severe CAD was defined as left main disease and/or three-vessel disease. Results: 1484 patients were enrolled in the study. The mean age within the cohort was 66.25 (11.47) years, with a predominant male representation (71.8%). Overall, 86.2% of patients exhibited CAD, while 32.9% had severe CAD. The median concentration of serum vitamin D was 17.25 [10.3 - 24.7] ng/ml, and hypovitaminosis D was observed in 59.7% of patients. The prevalence of hypovitaminosis D was significantly higher in women with severe CAD (74.1% vs 58.1%, p=0.002), whereas no statistically significant difference was noted among men with this clinical presentation (61.3% vs 57.1%, p=0.193). In female patients, hypovitaminosis D (OR: 1.85, p=0.013), alongside diabetes mellitus (DM) and advanced age, emerged as a predictive factor for severe CAD after adjusting for confounding variables such as glomerular filtration rate <60 mL/min/1.73 m², elevated cholesterol levels, and body mass index. However, hypovitaminosis D did not demonstrate independent predictive significance for severe CAD in male patients. Among female patients, those who had both hypovitaminosis D and DM exhibited a risk of more than three times higher for a severe CAD diagnosis compared to those who did not have hypovitaminosis D or DM (OR: 3.56 [1.8-7.03], p=0.021). Conclusion: The identification of hypovitaminosis D as a predictor for severe CAD specifically in women represents the original aspect of our research. Moreover, our findings highlight that the risk of the incidence of severe CAD is more than tripled for women having both vitamin D deficiency and DM.