Impact of Vitamin D Deficiency on Risk for Cardiovascular Outcomes, Mortality in Diabetes

Vitamin D
Vitamin D
A team of investigators sought to identify the relationship between serum 25 (OH)D concentration and cardiovascular disease events and mortality in patients with prediabetes or diabetes.

Monitoring and correcting vitamin D deficiency may prevent cardiovascular disease (CVD) events and mortality among adults with prediabetes or diabetes, according to the results of a study published in Diabetes Care.

Data for this study were sourced from the UK Biobank, which is a large population-based, prospective cohort study. Serum 25(OH)D concentrations were evaluated among individuals with prediabetes (n=67,789) or diabetes (n=24,311) and associations with risk for CVD outcomes and mortality were assessed. Prediabetes was defined as glycated hemoglobin (HbA1C) levels ranging from 5.7% to 6.4% and diabetes as an HbA1C level 6.5% and greater.

The prediabetes and diabetes cohorts included 54.3% and 43.7% women, mean age was 58.2±7.5 and 58.5±7.5 years, 92.2% and 88.1% were White, mean body mass index (BMI) was 28.4±5.1 and 30.7±5.9 kg/m2, and 57.7% and 63.5% engaged in less than 150 minutes of physical activity per week, respectively.

Among the cohort with prediabetes, 10,105 had low (<25.0 nmol/L), 29,309 intermediate-low (25.0-49.9 nmol/L), 21,891 had intermediate-high (50.0-74.9 nmol/L), and 6484 had high (≥75.0 nmol/L) serum 25(OH)D levels. Stratified by vitamin D concentrations, all baseline characteristics differed significantly (all P <.001).

For the cohort with diabetes, 4903 had low, 10,975 had intermediate-low, 6561 had intermediate-high, and 1872 had high serum 25(OH)D levels. All baseline characteristics differed on the basis of vitamin D concentrations (all P £.007) except for sex (P =.07).

The relationships between CVD and mortality outcomes with vitamin D concentrations were nonlinear, L-shaped associations.

Compared with low vitamin D, risk for CVD events (adjusted hazard ratio [aHR] range, 0.78-0.88), CVD mortality (aHR range, 0.43-0.65), all-cause mortality (aHR range, 0.59-0.77), coronary heart disease (aHR range, 0.79-0.90), and heart failure (aHR range, 0.66-0.77) decreased as vitamin D concentrations increased among either the prediabetes or diabetes cohorts (all P <.001).

Among the prediabetes group, risk for stroke (aHR range, 0.75-0.79; P =.009), ischemic stroke (aHR range, 0.75-0.77; P =.03), and hemorrhagic stroke (aHR range, 0.66-0.74; P =.03) was also inversely related with vitamin D concentration. No stroke outcomes were associated with vitamin D concentration among the cohort with diabetes.

In subgroup and sensitivity analyses, significant interactions were observed for female sex (P =.03), current smoking status (P <.001), older age (P =.04), obese status (P =.03), and White ethnicity (P =.02).

This study found that among the population with prediabetes and diabetes, lower serum vitamin D concentrations were associated with increased risk for CVD outcomes and mortality. These findings indicate that patients with diabetes or prediabetes should be monitored for vitamin D status and those with vitamin D deficiency may benefit from supplementation.


Zhang P, Guo D, Xu B, et al. Association of serum 25-hydroxyvitamin D with cardiovascular outcomes and all-cause mortality in individuals with prediabetes and diabetes: results from the UK Biobank Prospective Cohort Study. Diabetes Care. Published online February 28, 2022. doi:10.2337/dc21-2193