Association Between Serum Vitamin D Levels And Coronary Heart Disease And The Prognosis Of It

Background and Objective: A large number of clinical and epidemiological studies have shown that vitamin D deficiency is closely related to the incident and prognosis of coronary heart disease, but the exact mechanism remains unclear. Inflammation is an important factor contributing to plaque instability, which is throughout the development of atherosclerosis. TNF-a is a major inflammatory factors with a wide range of biological activities. IL-10 is an important anti-inflammatory cytokine. In physiological conditions, there maintains a dynamic balance between MMPs and TIMP, which regulate the degradation and reconstruction of the ECM jointly.Two hundred subjects were enrolled in this study and divided into coronary heart disease(CHD) group(150 cases) and control group(50 cases).Serum levels of 25-dihydroxyvitamin D[25(OH)D], MMP-2, TIMP-2, Interleukin-10(IL-10) and tumor necrosis factor-a(TNF-a)awere detected by ELISA.To evaluate the change of serum 25(OH)D level in CHD patients and the influence of vitamin D deficiency on the severity, disease progression and the prognosis of CHD.Method: Two hundred subjects were enrolled in this study and divided into control group(50 cases) and CHD group, including SAP(50 cases),UAP group(50 cases)and AMI group(50 cases) according to the coronary angiography.All of them were surveyed the previous history and the fasting lipid profile, blood glucose and insulin were tested. The serum levels of 25(OH)D, MMP-2, TIMP-2, IL-10, TNF-a were measured by ELISA., and(1) To compare the differences of clinical and biochemical indexes and serum 25(OH)D, MMP-2, TIMP-2, IL-10, TNF-a levels between CHD group and control group;(2) To compare all the parameters mentioned above between SAP,UAP and AMI group and between the single, double vessel disease and triple vessel disease group, and analyze the relationship between serum 25(OH)D and Gensini scores.(4) To evaluate the relationship between serum 25(OH)D and other cardiovascular risk factors.(5) To compare the MACE between 25(OH)D deficiency and non-deficiency group, then analyze the relationship between serum 25(OH)D and MACE by COX regression analysis.Results: 1. The serum levels of 25(OH)D in CHD group were significantly lower than that in control group, while the levels of MMP-2, TIMP-2, IL-10, TNF-a and MMP-2/TIMP-2 were significantly higher than control group.2. The serum levels of 25(OH)D in AMI group were significantly lower than that in UAP group, while the levels of MMP-2, TIMP-2, IL-10, TNF-a and MMP-2/TIMP-2 were significantly higher than UAP group(all P < 0.01). The serum levels of 25(OH)D in UAP group were significantly lower than that in SAP group, while the levels of MMP-2, TIMP-2, IL-10, TNF-a and MMP-2/TIMP-2, TNF-a/IL-10 were significantly higher than SAP group(all P < 0.01).3. The serum levels of 25(OH)D in triple vessel disease group were significantly lower than that in double vessel disease group, while the levels of MMP-2, TIMP-2, IL-10 and TNF-a were significantly higher than those in double vessel disease group(all P < 0.01). The serum levels of 25(OH)D in double vessel disease group were significantly lower than that in single vessel disease group, while the levels of MMP-2, TIMP-2, IL-10, TNF-a and MMP-2/TIMP-2, TNF-a/IL-10 were significantly higher than those in single vessel disease group(all P < 0.01).4. Pearson linear correlation analysis showed that the serum 25(OH)D levels were negatively associated with WHR,FBG,FIN,HOMA-IR,MMP-2,TIMP-2,MMP-2/TIMP-2,IL-10,TNF-a,TNF-a/IL-10 and Gensini scores respectively(P<0.05, P<0.01). Multiple linear regression analysis showed that the serum 25(OH)D levels were independently and negatively correlated with the Gensini scores(P<0.01). Logistic regression analysis showed that 25(OH)D was a protective factor of CHD.5. Vitamin D deficiency was not significantly associated with MACE in patients with CHD.Conclusion:1. The serum levels of vitamin D are significantly reduced in patients with coronary heart disease.2. Vitamin D has important influences on the incidence, severity and progression of the disease in CHD patients by regulating the balance of inflammatory cytokines and through the effects of cardiovascular risk factors possibly.3. Vitamin D deficiency is not significantly associated with MACE in patients with CHD, which may result from the small number of cases and the relatively short follow-up times, and further studies are still needed.