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American Journal of Epidemiology Advance Access originally published online on September 17, 2009
American Journal of Epidemiology 2009 170(8):1032-1039; doi:10.1093/aje/kwp227
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Vitamin D Status and the Risk of Cardiovascular Disease Death

Annamari Kilkkinen, Paul Knekt, Antti Aro, Harri Rissanen, Jukka Marniemi, Markku Heliövaara, Olli Impivaara and Antti Reunanen

Correspondence to Dr. Annamari Kilkkinen, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland (e-mail: annamari.kilkkinen{at}thl.fi).

Received for publication April 24, 2009. Accepted for publication July 1, 2009.

Accumulating evidence suggests that inadequate vitamin D levels may predispose people to chronic diseases. The authors aimed to investigate whether serum 25-hydroxyvitamin D (25(OH)D) level predicts mortality from cardiovascular disease (CVD). The study was based on the Mini-Finland Health Survey and included 6,219 men and women aged ≥30 years who were free from CVD at baseline (1978–1980). During follow-up through 2006, 640 coronary disease deaths and 293 cerebrovascular disease deaths were identified. Levels of 25(OH)D were determined from serum collected at baseline. Cox's proportional hazards model was used to assess the association between 25(OH)D and risk of CVD death. After adjustment for potential confounders, the hazard ratio for total CVD death was 0.76 (95% confidence interval (95% CI): 0.60, 0.95) for the highest quintile of 25(OH)D level versus the lowest. The association was evident for cerebrovascular death (hazard ratio = 0.48, 95% CI: 0.31, 0.75) but not coronary death (hazard ratio = 0.91, 95% CI: 0.70, 1.18). A low vitamin D level may be associated with higher risk of a fatal CVD event, particularly cerebrovascular death. These findings need to be replicated in other populations. To demonstrate a causal link between vitamin D and CVD, randomized controlled trials are required.

cardiovascular diseases; cohort studies; mortality; vitamin D

Abbreviations: CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; ICD, International Classification of Diseases; 25(OH)D, 25-hydroxyvitamin D; SD, standard deviation


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