Vitamin D deficiency and metabolic syndrome: The joint effect on cardiovascular and all-cause mortality in the United States adults

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dc.contributor.authorLiu, Longjianen
dc.contributor.authorCui, Saishien
dc.contributor.authorVolpe, Stella L.en
dc.contributor.authorMay, Nathalie S.en
dc.contributor.authorSukumar, Deepthaen
dc.contributor.authorDiMaria-Ghalili, Rose Annen
dc.contributor.authorEisen, Howard J.en
dc.coverage.countryUnited Statesen
dc.date.accessioned2022-10-27T16:50:03Zen
dc.date.available2022-10-27T16:50:03Zen
dc.date.issued2022-07-26en
dc.description.abstractBACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome (MetS) on cardiovascular disease (CVD) and all-cause mortality are still a matter of debate. AIM To test the hypotheses that lower serum 25 hydroxyvitamin D [25(OH)D] concentrations (a marker of vitamin D level) and MetS have a long-term impact on the risk of CVD and all-cause mortality, and individuals with vitamin D deficiency can be identified by multiple factors. METHODS A sample of 9094 adults, 20 to 90 years of age, who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994) were followed through December 2015 was analyzed. The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models. Classification and regression tree (CART) for machine learning was applied to classify individuals with vitamin D deficiency. RESULTS Of 9094 participants, 30% had serum 25(OH)D concentrations < 20 ng/mL (defined as vitamin D deficiency), 39% had serum 25(OH)D concentrations between 20 to 29 ng/mL (insufficiency), and 31% had serum 25(OH)D concentrations & GE;30 ng/mL (sufficiency). Prevalence of MetS was 28.4%. During a mean of 18 years follow-up, vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality. Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality (HR = 1.77, 95%CI: 1.22-2.58) and all-cause mortality (HR = 1.62, 95%CI: 1.26-2.09), followed by those with both vitamin D insufficiency and MetS for CVD mortality (HR = 1.59, 95%CI: 1.12-2.24), and all-cause mortality (HR = 1.41, 95%CI: 1.08-1.85). Meanwhile, vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS. Among the total study sample, CART analysis suggests that being non-Hispanic Black, having lower serum folate level, and being female were the first three predictors for those with serum 25(OH)D deficiency. CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality. There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality. Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.en
dc.description.versionPublished versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.4330/wjc.v14.i7.411en
dc.identifier.issn1949-8462en
dc.identifier.issue7en
dc.identifier.pmid36161059en
dc.identifier.urihttp://hdl.handle.net/10919/112298en
dc.identifier.volume14en
dc.language.isoenen
dc.publisherBaishideng Publishing Groupen
dc.rightsCreative Commons Attribution-NonCommercial 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/en
dc.subjectJoint effecten
dc.subjectSerum 25 hydroxyvitamin D concentrationen
dc.subjectMetabolic syndromeen
dc.subjectCardiovascular and all-cause mortalityen
dc.subjectCox model and machine learningen
dc.titleVitamin D deficiency and metabolic syndrome: The joint effect on cardiovascular and all-cause mortality in the United States adultsen
dc.title.serialWorld Journal of Cardiologyen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten

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