Vitamin D and acute myocardial infarction

Table 1 Most relevant risk factors for vitamin D deficiency

Age

Increased distance from the equator

Winter season

Darkly pigmented skin

Institutionalized/housebound

Sunscreens and cover-up clothing

Air pollution

Smoking

Obesity

Physical inactivity

Malabsorption

Chronic kidney disease

Liver disease

Drugs (glucocorticoids, antirejection medications, human immunodeficiency virus medications, antiepileptic drugs, etc.)

Table 2 Main prospective studies on serum vitamin D levels in patients with acute myocardial infarction

Ref.	Study population (n)	Definitions of vitamin D levels (ng/mL)	Prevalence	End points considered	Major findings
Lee et al[45]	NSTEMI STEMI (n = 219)	Normal > 30 insufficiency 21-29 deficiency < 20	4% were normal 75% were insufficient 21% were deficient	Prevalence and vitamin D correlates	Vitamin D deficiency was more commonly observed in non-Caucasian patients, in diabetics patients, and in those with a higher body mass index
Khalili et al[47]	STEMI (n = 139)	Deficiency < 30	73% were deficient	In-hospital mortality correlation with MMP-9 levels at 72 h	Inverse correlation between vitamin D and MMP-9 levels
Correia et al[46]	UA NSTEMI STEMI (n = 206)	Severe deficiency < 10	10% were severely deficient	In-hospital mortality long-term mortality (mean FU 635 d)	A significant higher incidence of in-hospital and long-term mortality in patients with severe vitamin D deficiency
Ng et al[13]	NSTEMI STEMI (n = 1259)	Deficiency < 20	74% were deficient	long-term incidence of mortality and MACE (median FU 550 d)	A significant higher incidence of MACE in patients with deficient vitamin D levels
De Metrio et al[12]	NSTEMI STEMI (n = 814)	Normal > 30 Insufficiency 21-29 Deficiency < 20	11% were normal 19% were insufficient 70% were deficient	In-hospital mortality and in-hospital MACE 1-yr mortality and 1-yr re-admission for acute coronary syndrome and acute decompensated heart failure	A higher incidence of in-hospital mortality, mechanical ventilation, and major bleeding in patients with the lowest quartile of vitamin D levels A significant higher incidence of 1-yr mortality and re-hospitalization for acute decompensated heart failure in patients with the lowest quartile of vitamin D levels
Aleksova et al[14]	NSTEMI STEMI (n = 478)	Sufficient > 30 Insufficiency 21-30 Deficiency ≤ 20	10% were sufficient 22% were insufficient 68% were deficient	Independent predictors of vitamin D deficiency	Older age, female gender, higher body mass index, autumn/winter sampling, and lower GFR predicted vitamin D deficiency

HR: Hazard ratio; FU: Follow-up; GFR: Glomerular filtration rate; MACE: Major adverse cardiac event; MMP-9: Matrix metalloproteinase-9; NSTEMI: Non-ST-elevation myocardial infarction; STEMI: ST-elevation myocardial infarction; UA: Unstable angina.