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Vol 17, No 1 (2022)
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Published online: 2022-02-28

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Daily sunshine hours as determinant of 25-hydroxyvitamin D concentration among diabetic cardiac patients who experienced myocardial infarction hospitalized due to acute coronary syndrome: a cross-sectional study

Ewelina A. Dziedzic1, Jakub S. Gąsior2, Paweł Płudowski3, William B. Grant4, Tomasz Saniewski5, Marek Dąbrowski6
Folia Cardiologica 2022;17(1):1-10.


Introduction. Vitamin D deficiency is a worldwide problem with a variety of health consequences. Vitamin D may reduce the risk of heart failure, however, evidence of the impact of vitamin D treatment on maintenance of cardiovascular health (i.e., preventing cardiovascular diseases) is conflicting due to lack of support from clinical trials. The reason for the failure of clinical trials to confirm an effect of vitamin D supplementation could be at least threefold: 1) too little vitamin D given to the participants or 2) lack of inclusion of only severely vitamin D-deficient populations or 3) study duration. The aim of this study was to characterize a group of cardiac patients who presented the lowest concentrations of 25-hydroxyvitamin D [25(OH)D]. Material and methods. Results of 92 diabetic cardiac patients aged between 41 and 89 years who experienced myocardial infarction, with significant coronary arteries changes, hospitalized due to acute coronary syndrome living in Warsaw were analyzed. Results. Patients presented median 25(OH)D concentration value of 11 ng/mL (range: 4–28 ng/mL). The only significant determinant of 25(OH)D concentration was the date of examination, with higher concentrations in summer than in winter. Conclusions. Vitamin D treatment in Polish cardiac patients aimed at reaching the optimal level of 30 ng/mL (75 nmol/L) seems to be necessary and implemented as soon as possible.

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  1. Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: a review of contemporary guidance and literature. JRSM Cardiovasc Dis. 2017; 6: 2048004016687211.
  2. Benjamin EJ, Blaha MJ, Chiuve SE, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017; 135(10): e146–e603.
  3. Turek-Jabrocka R, Szafraniec K, Pach D, et al. Metabolic syndrome as a useful tool in the identification of persons with an increased risk of nonfatal cardiovascular events in the Polish urban population — a prospective study. Folia Cardiologica. 2016; 11(4): 261–267.
  4. Cieśliński A, Pająk A, Podolec P, Rynkiewicz A. Ogólnopolski program prewencji choroby wieńcowej POLSCREEN. Termedia Wydawnictwo Medyczne, Poznań 2006: 27–34.
  5. Kozela M, Szafraniec K, Broda G, et al. POLKARD Study Group. Detection and treatment of hypercholesterolemia in primary health care. Results of the POLKARD program of the Ministry of Health of the Republic of Poland. Pol Arch Med Wewn. 2012; 122(4): 154–161.
  6. Waśkiewicz A, Piotrowski W, Sygnowska E, et al. Quality of nutrition and health knowledge in subjects with diagnosed cardio-vascular diseases in the Polish population — National Multicentre Health Survey (WOBASZ). Kardiol Pol. 2008; 66(5): 507–13, discussion 514.
  7. Mirhosseini N, Vatanparast H, Kimball SM. The association between serum 25(OH)D status and blood pressure in participants of a community-based program taking vitamin D supplements. Nutrients. 2017; 9(11): 1244.
  8. Raed A, Bhagatwala J, Zhu H, et al. Dose responses of vitamin D3 supplementation on arterial stiffness in overweight African Americans with vitamin D deficiency: a placebo controlled randomized trial. PLoS One. 2017; 12(12): e0188424.
  9. Muscogiuri G, Annweiler C, Duval G, et al. Vitamin D and cardiovascular disease: From atherosclerosis to myocardial infarction and stroke. Int J Cardiol. 2017; 230: 577–584.
  10. Wimalawansa SJ. Vitamin D and cardiovascular diseases: causality. J Steroid Biochem Mol Biol. 2018; 175: 29–43.
  11. Pludowski P, Holick MF, Grant WB, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018; 175: 125–135.
  12. Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008; 117(4): 503–511.
  13. Drechsler C, Pilz S, Obermayer-Pietsch B, et al. Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients. Eur Heart J. 2010; 31(18): 2253–2261.
  14. Vacek JL, Vanga SR, Good M, et al. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol. 2012; 109(3): 359–363.
  15. Correia LCL, Sodré F, Garcia G, et al. Relation of severe deficiency of vitamin D to cardiovascular mortality during acute coronary syndromes. Am J Cardiol. 2013; 111(3): 324–327.
  16. Porto CM, De Lima Silva V, da Luz JS, et al. Association between vitamin D deficiency and heart failure risk in the elderly. ESC Heart Fail. 2018; 5(1): 63–74.
  17. Hill A. The environment and disease: association or causation? J R Soc Med. 2015; 108(1): 32–37.
  18. Weyland PG, Grant WB, Howie-Esquivel J. Does sufficient evidence exist to support a causal association between vitamin D status and cardiovascular disease risk? An assessment using Hill's criteria for causality. Nutrients. 2014; 6(9): 3403–3430.
  19. Trehan N, Afonso L, Levine DL, et al. Vitamin D deficiency, supplementation, and cardiovascular health. Crit Pathw Cardiol. 2017; 16(3): 109–118.
  20. Al Mheid I, Quyyumi AA. Vitamin D and cardiovascular disease: controversy unresolved. J Am Coll Cardiol. 2017; 70(1): 89–100.
  21. Melamed ML, Michos ED, Post W, et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008; 168(15): 1629–1637.
  22. Grant WB, Karras SN, Bischoff-Ferrari HA, et al. Do studies reporting 'U'-shaped serum 25-hydroxyvitamin D-health outcome relationships reflect adverse effects? Dermatoendocrinol. 2016; 8(1): e1187349.
  23. Haines ST, Park SK. Vitamin D supplementation: what's known, what to do, and what's needed. Pharmacotherapy. 2012; 32(4): 354–382.
  24. Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clin Proc. 2010; 85(8): 752–757.
  25. Grant WB, Boucher BJ, Bhattoa HP, et al. Why vitamin D clinical trials should be based on 25-hydroxyvitamin D concentrations. J Steroid Biochem Mol Biol. 2018; 177: 266–269.
  26. Dziedzic EA, Przychodzeń S, Dąbrowski M. The effects of vitamin D on severity of coronary artery atherosclerosis and lipid profile of cardiac patients. Arch Med Sci. 2016; 12(6): 1199–1206.
  27. Dziedzic EA, Gąsior JS, Pawłowski M, et al. Association of vitamin D deficiency and degree of coronary artery disease in cardiac patients with type 2 diabetes. J Diabetes Res. 2017; 2017: 3929075.
  28. Krzywanski J, Mikulski T, Krysztofiak H, et al. Seasonal vitamin D status in Polish elite athletes in relation to sun exposure and oral supplementation. PLoS One. 2016; 11(10): e0164395.
  29. Sahota O. Understanding vitamin D deficiency. Age Ageing. 2014; 43(5): 589–591.
  30. Heaney RP. Vitamin D in health and disease. Clin J Am Soc Nephrol. 2008; 3(5): 1535–1541.
  31. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(7): 1911–1930.
  32. Al-Khalidi B, Kimball SM, Rotondi MA, et al. Standardized serum 25-hydroxyvitamin D concentrations are inversely associated with cardiometabolic disease in U.S. adults: a cross-sectional analysis of NHANES, 2001-2010. Nutr J. 2017; 16(1): 16.
  33. Engelsen O. The relationship between ultraviolet radiation exposure and vitamin D status. Nutrients. 2010; 2(5): 482–495.
  34. Tokarz A, Kusnierz-Cabala B, Kuźniewski M, et al. Seasonal effect of vitamin D deficiency in patients with acute myocardial infarction. Kardiol Pol. 2016; 74(8): 786–792.
  35. Brewer LC, Michos ED, Reis JP. Vitamin D in atherosclerosis, vascular disease, and endothelial function. Curr Drug Targets. 2011; 12(1): 54–60.
  36. Kassi E, Adamopoulos C, Basdra EK, et al. Role of vitamin D in atherosclerosis. Circulation. 2013; 128(23): 2517–2531.
  37. Dalan R, Liew H, Tan W, et al. Vitamin D and the endothelium: basic, translational and clinical research updates. IJC Metabolic & Endocrine. 2014; 4: 4–17.
  38. McGreevy C, Williams D. New insights about vitamin D and cardiovascular disease: a narrative review. Ann Intern Med. 2011; 155(12): 820–826.
  39. Pludowski P, Holick MF, Pilz S, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence. Autoimmun Rev. 2013; 12(10): 976–989.
  40. Pilz S, Verheyen N, Grübler MR, et al. Vitamin D and cardiovascular disease prevention. Nat Rev Cardiol. 2016; 13(7): 404–417.
  41. Martins D, Wolf M, Pan D, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007; 167(11): 1159–1165.
  42. Fanari Z, Hammami S, Hammami MB, et al. Vitamin D deficiency plays an important role in cardiac disease and affects patient outcome: Still a myth or a fact that needs exploration? J Saudi Heart Assoc. 2015; 27(4): 264–271.
  43. Yetley EA. Assessing the vitamin D status of the US population. Am J Clin Nutr. 2008; 88(2): 558S–564S.
  44. Mazidi M, Michos ED, Banach M. The association of telomere length and serum 25-hydroxyvitamin D levels in US adults: the National Health and Nutrition Examination Survey. Arch Med Sci. 2017; 13(1): 61–65.
  45. Zadshir A, Tareen N, Pan D, et al. The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis. 2005; 15(4 Suppl 5): 97–101.
  46. Hilger J, Friedel A, Herr R, et al. A systematic review of vitamin D status in populations worldwide. Br J Nutr. 2014; 111(1): 23–45.
  47. Pludowski P, Grant WB, Bhattoa HP, et al. Vitamin D status in Central Europe. Int J Endocrinol. 2014; 2014: 589587.
  48. Płudowski P, Ducki C, Konstantynowicz J, et al. Vitamin D status in Poland. Pol Arch Med Wewn. 2016; 126(7-8): 530–539.
  49. Pludowski P, Konstantynowicz J, Jaworski M, et al. Assessment of supply of vitamin D in the adult population in Poland. Standardy Med Pediatria. 2014; 4: 609–617.
  50. Rusińska A, Płudowski P, Walczak M, et al. Vitamin D supplementation guidelines for general population and groups at risk of vitamin D deficiency in poland-recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the expert panel with participation of national specialist consultants and representatives of scientific societies — 2018 update. Front Endocrinol (Lausanne). 2018; 9: 246.
  51. Wyskida M, Owczarek A, Szybalska A, et al. Socio-economic determinants of vitamin D deficiency in the older Polish population: results from the PolSenior study. Public Health Nutr. 2018; 21(11): 1995–2003.
  52. Kmieć P, Żmijewski M, Waszak P, et al. Vitamin D deficiency during winter months among an adult, predominantly urban, population in Northern Poland. Endokrynol Pol. 2014; 65(2): 105–113.
  53. Kmieć P, Żmijewski M, Lizakowska-Kmieć M, et al. Widespread vitamin D deficiency among adults from northern Poland (54°N) after months of low and high natural UVB radiation. Endokrynol Pol. 2015; 66(1): 30–38.
  54. Napiórkowska L, Budlewski T, Jakubas‑Kwiatkowska W, et al. Prevalence of low serum vitamin D concentration in an urban population of elderly women in Poland. Pol Arch Med Wewn. 2009; 119(11): 699–703.
  55. Trofimiuk-Muldner M, Kieć-Klimczak M, Hubalewska-Dydejczyk A. Niedobór witaminy D w populacji miasta Krakowa — wyniki wstępne. Endokrynol Pol. 2012; 63(Suppl. A): 160.
  56. Carvalho LS, Sposito AC. Vitamin D for the prevention of cardiovascular disease: Are we ready for that? Atherosclerosis. 2015; 241(2): 729–740.
  57. Veloudi P, Jones G, Sharman JE. Effectiveness of vitamin D supplementation for cardiovascular health outcomes. Pulse (Basel). 2016; 4(4): 193–207.
  58. Pramyothin P, Holick MF. Vitamin D supplementation: guidelines and evidence for subclinical deficiency. Curr Opin Gastroenterol. 2012; 28(2): 139–150.
  59. Pilz S, Kienreich K, Tomaschitz A, et al. Vitamin D and cardiovascular disease: update and outlook. Scand J Clin Lab Invest Suppl. 2012; 243: 83–91.
  60. Cashman KD, Ritz C, Kiely M, et al. Improved dietary guidelines for vitamin D: application of individual participant data (IPD)-level meta-regression analyses. Nutrients. 2017; 9(5): 469.
  61. Crowe FL, Steur M, Allen NE, et al. Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: results from the EPIC-Oxford study. Public Health Nutr. 2011; 14(2): 340–346.
  62. Bechthold A, Boeing H, Schwedhelm C, et al. Food groups and risk of coronary heart disease, stroke and heart failure: a systematic review and dose-response meta-analysis of prospective studies. Crit Rev Food Sci Nutr. 2019; 59(7): 1071–1090.
  63. Waśkiewicz A, Szcześniewska D, Szostak-Węgierek D, et al. Are dietary habits of the Polish population consistent with the recommendations for prevention of cardiovascular disease? — WOBASZ II project. Kardiol Pol. 2016; 74(9): 969–977.
  64. Karczmarewicz E, Czekuć-Kryśkiewicz E, Płudowski P, et al. Effect of vitamin D status on pharmacological treatment efficiency: Impact on cost-effective management in medicine. Dermatoendocrinol. 2013; 5(2): 299–304.
  65. European Food Safety Authority. Scientific opinion on the tolerable upper intake level of vitamin D. EFSA Journal. 2012; 10(7): 2813.
  66. Lichthammer A, Nagy B, Orbán C, et al. A comparative study of eating habits, calcium and vitamin D intakes in the population of Central-Eastern European countries. New Medicine. 2015; 19(2): 66–70.
  67. Grant WB. An estimate of the global reduction in mortality rates through doubling vitamin D levels. Eur J Clin Nutr. 2011; 65(9): 1016–1026.
  68. Grant WB, Whiting SJ, Schwalfenberg GK, et al. Estimated economic benefit of increasing 25-hydroxyvitamin D concentrations of Canadians to or above 100 nmol/L. Dermatoendocrinol. 2016; 8(1): e1248324.
  69. Forrest KYZ, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011; 31(1): 48–54.
  70. Whayne TF. Vitamin d: popular cardiovascular supplement but benefit must be evaluated. Int J Angiol. 2011; 20(2): 63–72.
  71. Kühn T. Vitamin D deficiency in urban Poland: what are the implications? Pol Arch Med Wewn. 2016; 126(7-8): 468–470.
  72. Department of Health and Human Services. Food and Drug Administration. Food additives permitted for direct addition to food for human consumption. Federal Register. 2016; 81(137): 46578–46582.
  73. Zittermann A. Magnesium deficit ? overlooked cause of low vitamin D status? BMC Med. 2013; 11: 229.
  74. Shirazi L, Almquist M, Malm J, et al. Determinants of serum levels of vitamin D: a study of life-style, menopausal status, dietary intake, serum calcium, and PTH. BMC Womens Health. 2013; 13: 33.