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25-Hydroxyvitamin D Levels Inversely Associate with Risk for Developing Coronary Artery Calcification

Ian H. de Boer^*,, Bryan Kestenbaum^*,, Abigail B. Shoben, Erin D. Michos, Mark J. Sarnak^|| and David S. Siscovick^*

*Department of Medicine,
Division of Nephrology, and
Department of Biostatistics, University of Washington, Seattle, Washington;
Department of Medicine, Johns Hopkins University, Baltimore, Maryland; and
^||Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts

Correspondence: Dr. Ian H. de Boer, Division of Nephrology, University of Washington, Box 356521, 1959 NE Pacific Street, Seattle, WA 98195. Phone: 206-616-5403; Fax: 206-685-2473; E-mail: deboer{at}u.washington.edu

Received for publication November 10, 2008. Accepted for publication March 17, 2009.

Vitamin D deficiency associates with increased risk for cardiovascular events and mortality, but the mechanism driving this association is unknown. Here, we tested whether circulating 25-hydroxyvitamin D concentration associates with coronary artery calcification (CAC), a measure of coronary atherosclerosis, in the Multi-Ethnic Study of Atherosclerosis. We included 1370 participants: 394 with and 976 without chronic kidney disease (estimated GFR <60 ml/min per 1.73 m²). At baseline, CAC was prevalent among 723 (53%) participants. Among participants free of CAC at baseline, 135 (21%) developed incident CAC during 3 yr of follow-up. Lower 25-hydroxyvitamin D concentration did not associate with prevalent CAC but did associate with increased risk for developing incident CAC, adjusting for age, gender, race/ethnicity, site, season, physical activity, smoking, body mass index, and kidney function. Further adjustment for BP, diabetes, C-reactive protein, and lipids did not alter this finding. The association of 25-hydroxyvitamin D with incident CAC seemed to be stronger among participants with lower estimated GFR. Circulating 1,25-dihydroxyvitamin D concentrations among participants with chronic kidney disease did not significantly associate with prevalent or incident CAC in adjusted models. In conclusion, lower 25-hydroxyvitamin D concentrations associate with increased risk for incident CAC. Accelerated development of atherosclerosis may underlie, in part, the increased cardiovascular risk associated with vitamin D deficiency.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673