Background: Hypovitaminosis D is a common condition among patients with cardiovascular diseases and it is closely associated with inflammation, oxidative stress, endothelial dysfunction, diabetes mellitus (DM), insulin resistance and anemia.
Aims and methods: We aim to assess the prevalence and persistence of hypovitaminosis D (<20 ng/ml) over years among 1510 patients with acute myocardial infarction (AMI), admitted at the University Hospital in Trieste. To access changes in vitamin D values over the years, we separated the patients into 4 groups according to the year of enrolment: group 1 (2009-2010), group 2 (2014-2016), group 3 (2017-2019) and group 4 (2020-2022).
Results: The median vitamin D concentration in our cohort was 17.15 (10.2 – 24.7) ng/ml, meaning that the majority of enrolled patients were vitamin D deficient (59.7%). Comparing the defined groups, it is observed that the plasma vitamin D values significantly increased during the years respectively: 14.45 (7.73 – 22.58) ng/ml vs 17.3 (10.28 – 24.2) ng/ml vs 18.95 (11.63 – 26.78) ng/ml vs 19.05 (12.5 – 27.3) ng/ml, p<0.0001 (Figure 1). Vitamin D was negatively correlated with Galactin-3, glucose levels, HbA1C and pro-inflammatory markers such as CRP, TNF-α and Il-1β.
Patients with DM have significantly lower levels of vitamin D compared to patients without (respectively: 18.95 (13.25 – 27.18) ng/ml vs 22.8 (14.1 – 31.5) ng/ml p<0.001). Furthermore, anemic patients have lower vitamin D levels compared to patients without (respectively, 13.7 (8.0 – 22.65) ng/ml vs 18.4 (11.5 – 25.5) ng/ml, p<0.0001). In a multivariate analysis, hypovitaminosis D was predicted by fall-winter sampling (p<0.0001), higher body mass index (p=0.001), DM (p=0.001), smoking (p=0.001), older age (p=0.008), increased triglyceride levels (p=0.01) and female gender (p=0.038).
Conclusions: Hypovitaminosis D remains common among patients with AMI, although there is a trend of increasing vitamin D values over the years probably due to media awareness. Supplementation of vitamin D should be mandatory in patients with cardiovascular diseases given its close relationship with DM and anemia and their association with mortality.