Assessing the Relationship Between Vitamin D Deficiency, T1D, and Coronary Disease

Vitamin D deficiency (VDD) is prevalent in pancreas transplant candidates with type 1 diabetes (T1D) and is associated with an increased prevalence of coronary disease, according to results of a cross-sectional study. Findings were published in Frontiers in Endocrinology.

Despite being an established method of treatment for certain patients with T1D, pancreas transplantation “is associated with a high risk of cardiovascular events, and cardiovascular complications are still the most common cause of death in this group of patients,” the researchers explained.

Patients with T1D are already at an increased of cardiovascular disease due to the adverse effects of hyperglycemia, while additional risk factors are thought to impact the prevalence of coronary artery disease (CAD) in this population.

Because individuals with T1D present with VDD more often than the general population, investigators sought to determine the prevalence of VDD among pancreas transplant candidates with T1D. They also assessed the relationship between vitamin D status and prevalence of CAD and between vitamin D and lipid profile.

Forty-eight patients were recruited from a medical center in Poland between August 2018 and September 2020. As part of the cross-sectional study, researchers collected demographic and medical data and all participants underwent a coronary angiography.

The mean (SD) participant age was 41.6 (8) years and 50% were male. The majority of patients (66.7%) were eligible for simultaneous pancreas/kidney transplantation and the rest for pancreas transplant alone.

“VDD was revealed in 48% of patients and CAD in 35% of patients. The mean concentration of vitamin D in the entire cohort was 21.3 (9.48) ng/mL,” the authors wrote.

Analyses revealed:

• The median (interquartile range) value of 25-hydroxyvitamin D (25(OH)D) in patients with CAD was significantly lower than in patients without CAD (18.5 11.6-21.5] vs 24.8 [18.4-31.8] ng/mL; P = .018)
• There was a significant relationship between VDD and CAD (odds ratio [OR], 4.36; 95% CI, 1.22-5.64; P = .034)
• A patient’s odds of having CAD while having a sufficient level of vitamin D was 4.36 times lower than if the patient had VDD
• There was a significant relationship between VDD and hypertension (OR, 5.91; 95% CI, 1.12-31.20; P = .039) and hemodialysis (OR, 4.25; 95% CI, 1.25-14.5; P = .023)
• There was no significant correlation between 25(OH)D and lipid profile

Results indicate measurement of serum 25(OH)D levels plays a key role in the diagnosis and treatment of VDD in this group of patients, the researchers explained.

The fact that the majority of study participants used statins may explain the lack of a relationship between vitamin D levels and lipid profiles. They noted the association between VDD and increased incidence of CAD is thus likely not due to lipid effects.

The cross-sectional nature of the study and a single timepoint of assessment of vitamin D status used mark limitations.

Overall, “VDD may represent an additional, modifiable cardiovascular risk factor among pancreas transplant candidates with T1D. The measurement of 25(OH)D concentration should be considered in all type 1 diabetic patients eligible for pancreas transplantation,” the authors concluded.

More research is needed to confirm the existence of a cause-and-effect relationship between CAD and VDD, they added.

Reference

Buksińska-Lisik M, Kwasiborski PJ, Ryczek R, Lisik W, Mamcarz A. Vitamin d deficiency as a predictor of a high prevalence of coronary artery disease in pancreas transplant candidates with type 1 diabetes. Front Endocrinol. Published online August 11, 2021. doi:10.3389/fendo.2021.714728