Vitamin D and risk of death from vascular and non-vascular causes in the Whitehall study and meta-analyses of 12,000 deaths

Eur Heart J. 2013 May;34(18):1365-74. doi: 10.1093/eurheartj/ehs426. Epub 2012 Dec 20.

Abstract

Aims: To examine the independent relevance of plasma concentrations of 25-hydroxyvitamin D [25(OH)D] for vascular and non-vascular mortality.

Methods and results: We examined associations of plasma concentrations of 25(OH)D and cause-specific mortality in a prospective study of older men living in the UK and included findings in meta-analyses of similar studies identified by a systematic search reporting on vascular and all-cause mortality. In a 13-year follow-up of 5409 men (mean baseline age 77 years), 1358 died from vascular and 1857 from non-vascular causes. Median season-adjusted baseline 25(OH)D concentration was 56 (interquartile range: 45-67) nmol/L. After adjustment for age and seasonality, higher concentrations of 25(OH)D were inversely and approximately linearly (log-log scale) associated with vascular and non-vascular mortality throughout the range 40-90 nmol/L. After additional adjustment for prior disease and cardiovascular risk factors, a doubling in 25(OH)D concentration was associated with 20% [95% confidence interval (CI): 9-30%] lower vascular and 23% (95% CI: 14-31%) lower non-vascular mortality. In meta-analyses of prospective studies, individuals in the top vs. bottom quarter of 25(OH)D concentrations had 21% (95% CI: 13-28%) lower vascular and 28% (95% CI: 24-32%) lower all-cause mortality.

Conclusions: Despite strong inverse and apparently independent associations of 25(OH)D with vascular and non-vascular mortality, causality remains uncertain. Large-scale randomized trials, using high doses of vitamin D, are required to assess the clinical relevance of these associations.

Keywords: Cardiovascular disease; Mortality; Vitamin D.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / mortality
  • Humans
  • London / epidemiology
  • Male
  • Neoplasms / blood
  • Neoplasms / mortality
  • Prospective Studies
  • Risk Factors
  • Vitamin D / analogs & derivatives*
  • Vitamin D / metabolism
  • Vitamin D Deficiency / mortality*

Substances

  • Vitamin D
  • 25-hydroxyvitamin D