期刊
AMERICAN HEART JOURNAL
卷 164, 期 3, 页码 387-393出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.ahj.2012.06.016
关键词
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资金
- Pfizer, Inc.
- Pfizer
- GlaxoSmithKline
- Hoffman La Roche
- Gilead
- NIH/Abbott
- Spirocor Ltd
- NIH/Yale
- Kowa
- Amarin
- CV Therapeutics
- Sanofi-Aventis
- Schering-Plough
- AstraZeneca
- Abbott
- Merck
- Boston Scientific
- Medtronic
- Gilead Sciences
- Genzyme
- Eli Lilly
- National Heart, Lung, and Blood Institute
- Anthera
- Aegerion
- Biosante
- Bristol-Myers Squibb
- Cerenis
- Genentech
- Merck/Schering-Plough
- Roche CSL
- Amgen
- Pfizer Inc
Background This post hoc nested case-control analysis of the TNT study was designed to investigate whether baseline vitamin D level is a significant predictor of cardiovascular risk among statin-treated patients and whether changes in vitamin D after treatment with atorvastatin are associated with improved cardiovascular outcomes. Methods A total of 10,001 patients with stable coronary heart disease were randomized to atorvastatin 80 or 10 mg for a median of 4.9 years. This analysis included 1,509 patients (497 with a subsequent cardiovascular event and 1,012 without an event) with vitamin D levels determined at baseline and 1 year. Event rates were analyzed by Cox proportional hazard model by baseline vitamin D levels, with vitamin D as a continuous variable, and with change in vitamin D level as the predictor. Results Vitamin D deficiency (<15 ng/mL) or insufficiency (15-<30 ng/mL) was present in 108 (7.2%) of 1,509 and 625 (41.4%) of 1,509 of patients, whereas 46 (3.0%) of 1,509 had elevated vitamin D. There was no relationship between baseline vitamin D levels or change in vitamin D levels and cardiovascular events or mortality. Modeling of events with vitamin D as a continuous variable similarly showed no relationship of vitamin D to events. These findings held true after adjustment for seasonal variations in vitamin D and other confounders. Conclusion In statin-treated patients with stable coronary heart disease, vitamin D levels did not predict cardiovascular risk. Changes in plasma concentrations of vitamin D after 1 year of treatment made no contribution to the efficacy of atorvastatin therapy. (Am Heart J 2012;164:387-93.)
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