Vitamin D status and the risk of cardiovascular disease death. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. Evidence for the vitamin D hypothesis: The NHANES III extended mortality follow-up. Calcium plus vitamin D supplementation and mortality in postmenopausal women: the Women's Health Initiative calcium-vitamin D randomized controlled trial. The D-Health Trial: A randomized trial of vitamin D for prevention of mortality and cancer. Long-term follow-up for mortality and cancer in a randomized placebo-controlled trial of vitamin D(3) and/or calcium (RECORD trial). Nutritional status and subsequent all-cause mortality in men and women aged 75 years or over living in the community. A prospective study of serum 25-hydroxyvitamin d levels and mortality among African Americans and non-African Americans. Prospective association of vitamin D concentrations with mortality in postmenopausal women: results from the Women's Health Initiative (WHI). Effects of monthly dose and regular dosing of intravenous active vitamin D use on mortality among patients undergoing hemodialysis. Effect of weekly vitamin D supplements on mortality, morbidity, and growth of low birthweight term infants in India up to age 6 months: randomised controlled trial Low Serum Vitamin D is Not Associated with an Increase in Mortality in Oldest Old Subjects: The Octabaix Three-Year Follow-Up Study Association of serum 25-hydroxyvitamin D with the risk of death in a general older population in Finland Low Serum Levels of 25-Hydroxyvitamin D Predict Fatal Cancer in Patients Referred to Coronary Angiography Sun, vitamin D, and cardiovascular disease. The effect of vitamin D and frailty on mortality among non-institutionalized US older adults Serum 25(OH)D Is a 2-Year Predictor of All-Cause Mortality, Cardiac Death and Sudden Cardiac Death in Chest Pain Patients from Northern Argentina
Accumulating evidence suggests that inadequate vitamin D levels may predispose people to chronic diseases . The authors aim ed to investigate whether serum 25-hydroxyvitamin D ( 25(OH)D ) level predicts mortality from cardiovascular disease ( CVD ) . The study was based on the Mini-Finl and Health Survey and included 6,219 men and women aged > or = 30 years who were free from CVD at baseline ( 1978 - 1980 ) . During follow-up through 2006 , 640 coronary disease deaths and 293 cerebrovascular disease deaths were identified . Levels of 25(OH)D were determined from serum collected at baseline .  Cox 's proportional hazards model was used to assess the association between 25(OH)D and risk of CVD death . After adjustment for potential confounders , the hazard ratio for total CVD death was 0.76 ( 95 % confidence interval ( 95 % CI ) : 0.60 , 0.95 ) for the highest quintile of 25(OH)D level versus the lowest . The association was evident for cerebrovascular death ( hazard ratio = 0.48 , 95 % CI : 0.31 , 0.75 ) but not coronary death ( hazard ratio = 0.91 , 95 % CI : 0.70 , 1.18 ) . A low vitamin D level may be associated with higher risk of a fatal CVD event , particularly cerebrovascular death . These findings need to be replicated in other population s. To demonstrate a causal link between vitamin D and CVD , r and omized controlled trials are required BACKGROUND Vitamin D has potent anticancer properties , especially against digestive-system cancers . Many human studies have used geographic residence as a marker of solar ultraviolet B and hence vitamin D exposure . Here , we considered multiple determinants of vitamin D exposure ( dietary and supplementary vitamin D , skin pigmentation , adiposity , geographic residence , and leisure-time physical activity-to estimate sunlight exposure ) in relation to cancer risk in the Health Professionals Follow-Up Study . METHODS Among 1095 men of this cohort , we quantified the relation of these six determinants to plasma  25-hydroxy-vitamin D [ 25(OH)D ] level by use of a multiple linear regression model . We used results from the model to compute a predicted 25(OH)D level for each of 47,800 men in the cohort based on these characteristics . We then prospect ively examined this variable in relation to cancer risk with multivariable Cox proportional hazards models . RESULTS From 1986 through January 31 , 2000 , we documented 4286 incident cancers ( excluding organ-confined prostate cancer and nonmelanoma skin cancer ) and 2025 deaths from cancer . From multivariable models , an increment of 25 nmol/L in predicted 25(OH)D level was associated with a 17 % reduction in total cancer incidence ( multivariable relative risk [ RR ] = 0.83 , 95 % confidence interval [ CI ] = 0.74 to 0.92 ) , a 29 % reduction in total cancer mortality ( RR = 0.71 , 95 % CI = 0.60 to 0.83 ) , and a 45 % reduction in digestive-system cancer mortality ( RR = 0.55 , 95 % CI = 0.41 to 0.74 ) . The absolute annual rate of total cancer was 758 per 100,000 men in the bottom decile of predicted 25(OH)D and 674 per 100,000 men for the top decile ; these respective rates were 326 per 100,000 and 277 per 100,000 for total cancer mortality and 128 per 100,000 and 78 per 100,000 for digestive-system cancer mortality . Results were similar when we controlled further for body mass index or physical activity level . CONCLUSIONS Low levels of vitamin D may be associated with increased cancer incidence and mortality in men , particularly for digestive-system cancers . The vitamin D supplementation necessary to achieve a 25(OH)D increment of 25 nmol/L may be at least 1500 IU/day BACKGROUND AND AIMS Emerging evidence suggests that low levels of vitamin D may be an important risk factor for multiple chronic diseases and mortality , but the evidence is mixed . Vitamin D levels are associated with sun exposure , diet , and metabolic status . One potential explanation for the lack of consistent findings amongst various studies is that low vitamin levels may be associated with poor diets or other risk factors that we were not adequately controlled for in different analyses . METHODS Prospect i ve analysis of adults over the age of 35 in NHANES III data ( 1988 - 1994 ) with 20 year mortality follow-up . Sequential Cox proportional hazard models quartiles of 25OH vitamin D adjusted for age , season , geography , sociodemographic ( SD ) , CVD risk factors ( CVD ) and nutritional factors ( NF ) were performed . RESULTS Gender , race , diabetes , anti-hypertensive meds , income , taking  vitamin D supplements , physical activity , alcohol consumption , region , body mass index , blood pressure , creatinine , albumin , CRP , thyroxine , iron , RBC folate , vitamin A , E , alpha-carotene , and lycopene were all associated with different quartiles of vitamin D and as well as CHD and all-cause mortality and thus are important potential confounders of this relationship . Adjusting for the confounding factors , higher levels of vitamin D demonstrate an inverse relationship with all-cause mortality , but only the top quartile of vitamin D shows an inverse relationship with CHD mortality . CONCLUSIONS The highest quartile compared to the lowest quartile of 25OH vitamin D levels is inversely associated with CHD and all-cause mortality adjusting for multiple confounders . Whether supplementation of individuals with low vitamin D will result in similar benefits will require a r and omized clinical trial BACKGROUND Calcium and vitamin D ( CaD ) supplementation trials including the Women 's Health Initiative ( WHI ) trial of CaD have shown nonsignificant reductions in total mortality . This report examines intervention effects on total and cause-specific mortality by age and adherence . METHODS The WHI CaD trial was a r and omized , double-blind , placebo-controlled trial that enrolled 36,282 postmenopausal women aged 51 - 82 years from 40 U.S. clinical centers . Women were assigned to 1,000 mg of elemental calcium carbonate and 400 IU of vitamin D(3 ) daily or placebo with average follow-up of 7.0 years . RESULTS The hazard ratio ( HR ) for total mortality was 0.91 ( 95 % confidence interval [ CI ] , 0.83 - 1.01 ) with 744 deaths in women r and omized to CaD versus 807 deaths in the placebo group . HRs were in the direction of reduced risk but nonsignificant for stroke and cancer mortality , but near unity for coronary heart disease and other causes of death . HRs for total mortality were 0.89 in the 29,942 women younger than 70 years ( 95 % CI , 0.79 - 1.01 ) and 0.95 in the 6,340 women aged 70 and older ( 95 % CI , 0.80 - 1.12 ; p value for age interaction = .10 ) . No statistically significant interactions were observed for any baseline characteristics . Treatment effects did not vary significantly by season . CONCLUSIONS In the WHI CaD trial , supplementation did not have a statistically significant effect on mortality rates but the findings support the possibility that these supplements may reduce mortality rates in postmenopausal women . These data can neither support nor refute recommendations for higher dose vitamin D supplementation to reduce cancer or total mortality BACKGROUND Vitamin D , specifically serum 25(OH)D has been associated with mortality , cancer and multiple other health endpoints in observational studies , but there is a paucity of clinical trial evidence sufficient to determine the safety and effectiveness of population -wide supplementation . We have therefore launched the D-Health Trial , a r and omized trial of vitamin D supplementation for prevention of mortality and cancer . Here we report the methods and describe the trial cohort . METHODS The D-Health Trial is a r and omized placebo-controlled trial , with planned intervention for 5years and a further 5years of passive follow-up through linkage with health and death registers . Participants aged 65 - 84years were recruited from the general population of Australia . The intervention is monthly oral doses of 60,000IU of cholecalciferol or matching placebo . The primary outcome is all-cause mortality . Secondary outcomes are total cancer incidence and colorectal cancer incidence . RESULTS We recruited 21,315 participants to the trial between February 2014 and May 2015 . The participants in the two arms of the trial were well-balanced at baseline . Comparison with Australian population statistics shows that the trial participants were less likely to report being in fair or poor health , to be current smokers or to have diabetes than the Australian population . However , the proportion overweight or with health conditions such as arthritis and angina was similar . CONCLUSIONS Observational data can not be considered sufficient to support interventions delivered at a population level . Large-scale r and omized trials such as the D-Health Trial are needed to inform public health policy and practice CONTEXT Vitamin D or calcium supplementation may have effects on  vascular disease and cancer .  OBJECTIVE Our objective was to investigate whether vitamin D or calcium supplementation affects mortality , vascular disease , and cancer in older people . DESIGN AND SETTING The study included long-term follow-up of participants in a two by two factorial , r and omized controlled trial from 21 orthopedic centers in the United Kingdom . PARTICIPANTS Participants were 5292 people ( 85 % women ) aged at least 70 yr with previous low-trauma fracture . INTERVENTIONS Participants were r and omly allocated to daily vitamin D(3 ) ( 800 IU ) , calcium ( 1000 mg ) , both , or placebo for 24 - 62 months , with a follow-up of 3 yr after intervention . MAIN OUTCOME MEASURES All-cause mortality , vascular disease mortality , cancer mortality , and cancer incidence were evaluated . RESULTS In intention-to-treat analyses , mortality [ hazard ratio ( HR ) = 0.93 ; 95 % confidence interval ( CI ) = 0.85 - 1.02 ] , vascular disease mortality ( HR = 0.91 ; 95 % CI = 0.79 - 1.05 ) , cancer mortality ( HR = 0.85 ; 95 % CI = 0.68 - 1.06 ) , and cancer incidence ( HR = 1.07 ; 95 % CI = 0.92 - 1.25 ) did not differ significantly between participants allocated vitamin D and those not . All-cause mortality ( HR = 1.03 ; 95 % CI = 0.94 - 1.13 ) , vascular disease mortality ( HR = 1.07 ; 95 % CI = 0.92 - 1.24 ) , cancer mortality ( HR = 1.13 ; 95 % CI = 0.91 - 1.40 ) , and cancer incidence ( HR = 1.06 ; 95 % CI = 0.91 - 1.23 ) also did not differ significantly between participants allocated calcium and those not . In a post hoc statistical analysis adjusting for compliance , thus with fewer participants , trends for reduced mortality with vitamin D and increased mortality with calcium were accentuated , although all results remain nonsignificant . CONCLUSIONS Daily vitamin D or calcium supplementation did not affect mortality , vascular disease , cancer mortality , or cancer incidence We prospect ively investigated relationships between blood markers of Fe , vitamin B12 , folate , vitamin C and vitamin D status and subsequent  all-cause mortality  in 208 men and 191 women aged 75 years or over living in the community in Aberdeen , Scotl and . The participants had been recruited for a cross-sectional study in 1999 - 2000 when they completed health and lifestyle question naires  and had blood sample s taken for analysis of serum ferritin , serum vitamin B12 , erythrocyte folate , plasma vitamin C and serum 25-hydroxycholecalciferol .  Mortality was ascertained on national data bases up to December 2005 , with a median time of follow up of 69.2 ( range 1.0 - 79.9 ) months . Participants were divided into sex-specific quintiles of baseline levels for each nutrient , and hazard ratios were estimated with Cox proportional hazard models adjusted for age and sex with the significance of linear trends in the associations assessed by logistic regression . There was no significant association between blood markers of Fe , vitamin B12 or folate status at baseline and mortality , but  vitamin D status at baseline was inversely related to mortality ( P for trend < 0.001 ) . For vitamin C there was no evidence of a linear trend but participants in the lowest quintile of plasma levels had a significantly higher risk of death than those in the highest quintile . R and omized controlled trials of lifestyle changes which improve vitamin status are needed to assess whether these associations could be causal The beneficial biologic effects attributed to vitamin D suggest a potential to influence overall mortality . Evidence addressing this hypothesis is limited , especially for African Americans who have a high prevalence of vitamin D insufficiency . The authors conducted a nested case-control study within the prospect i ve Southern Community Cohort Study to relate baseline serum levels of 25-hydroxyvitamin D ( 25(OH)D ) with subsequent mortality .  Cases were 1,852 participants who enrolled from 2002 to 2009 and died > 12 months postenrollment . Controls ( n = 1,852 ) were matched on race , sex , age , enrollment site , and blood collection date . The odds ratios for quartile 1 ( < 10.18 ng/mL ) versus quartile 4 ( > 21.64 ng/mL ) levels of 25(OH)D were 1.60 ( 95 % confidence interval ( CI ) : 1.20 , 2.14 ) for African Americans and 2.11 ( 95 % CI : 1.39 , 3.21 ) for non-African Americans . The effects were strongest for circulatory disease death , where quartile 1 versus quartile 4 odds ratios were 2.53 ( 95 % CI : 1.44 , 4.46 ) and 3.25 ( 95 % CI : 1.33 , 7.93 ) for African Americans and non-African Americans , respectively . The estimated odds of total mortality were minimized in the 25(OH)D range of 35 - 40 ng/mL. These findings provide support for the hypothesis that vitamin D status may have an important influence on mortality for both African Americans and non-African Americans BACKGROUND Prospect i ve epidemiologic data on the association between vitamin D and all-cause and cause-specific mortality are limited . OBJECTIVE This study aim ed to determine whether 25-hydroxyvitamin D [ 25(OH)D ]  concentrations were prospect ively and independently associated with cardiovascular disease ( CVD ) , cancer , and all-cause mortality in postmenopausal women . DESIGN A sub study in 2429 postmenopausal women within the Women 's Health Initiative ( WHI ) with measured baseline 25(OH)D concentrations were followed for 10 y for death from CVD , cancer , and all-cause mortality . Proportional hazards models were performed to evaluate quartiles of month-adjusted 25(OH)D concentrations , with adjustment for potential confounders . Sequential model building and analysis for multiplicative interaction were performed to evaluate the effects of central adiposity on the association of low 25(OH)D with all-cause mortality . RESULTS Of the 2429 women , 224 deaths occurred , with 79 deaths from CVD and 62 deaths from cancer . Multivariate-adjusted HRs that compared quartiles 1 ( lowest ) to 4 ( highest ) of 25(OH)D for all-cause mortality ( HR : 1.25 ; 95 % CI : 0.80 , 1.95 ) , CVD mortality ( HR : 1.27 ; 95 % CI : 0.81 , 1.99 ) , and cancer mortality ( HR : 1.39 ; 95 % CI : 0.88 , 2.19 ) were not significant . There was a potential interaction ( P = 0.08 ) between abdominal obesity and low 25(OH)D concentrations that showed an increased risk of the lowest quartile of 25(OH)D concentrations ( HR : 1.85 ; 95 % CI : 1.00 , 3.44 ) with increased mortality in women with a normal waist circumference but no increased risk in women with abdominal obesity ( HR : 0.96 ; 95 % CI : 0.52 , 1.76 ) . CONCLUSION Body fat distribution may play an important role in the modulation of the effect of low vitamin D concentrations on health . This trial was registered at clinical trials.gov as NCT 00000611 STUDY OBJECTIVES To determine if apparent protective mortality benefits of intravenous active vitamin D in patients undergoing hemodialysis extend across all groups defined by dialysis duration ; if higher monthly dose and dosing regularity are associated with reduced mortality ; and if intravenous active vitamin D use is associated with reduced cardiovascular , infectious , and cancer-related mortality . STUDY DESIGN Retrospective cohort study . DATA SOURCE Centers for Medicare and Medicaid Services End-Stage Renal Disease data base . PATIENTS A total of 193,830 patients undergoing hemodialysis during 1999 - 2000 , of whom 94,208 ( 48.6 % ) were taking intravenous active vitamin D in the baseline period . MEASUREMENTS AND MAIN RESULTS Time-varying Cox proportional hazards models were used to assess the effects of monthly vitamin D dose and dosing regularity over 3-month intervals on risk of all-cause and cause-specific death , by dialysis duration groups ( < 1 yr , 1 to <3 yrs , 3 to < 5 yrs , and > or=5 yrs from dialysis initiation ) . Models were adjusted for baseline characteristics , time-varying hospital days , monthly epoetin alfa dose , mean hemoglobin level , and urea reduction ratio in the 3-month intervals . Maximum follow-up time was 5.25 years . Adjusted all-cause mortality risk was reduced 7 - 17 % among patients receiving vitamin D each month of the 3-month interval , with the highest reduction among patients with shorter dialysis duration . However , regular vitamin D dosing did not show consistent benefit across dialysis duration groups for cardiovascular , infectious , cancer , or other ( all deaths not attributable to cardiovascular disease , infection , or cancer ) mortality . CONCLUSION Mortality benefits of intravenous vitamin D can not be easily explained by currently proposed biologic mechanisms . R and omized controlled trials are needed to show definitively whether intravenous vitamin D can reduce all-cause and cause-specific mortality in patients undergoing dialysis compared with placebo Objective To investigate whether vitamin D supplementation can decrease the mortality and morbidity of low birthweight infants in low income countries . Design R and omised controlled trial . Setting Large government hospital in New Delhi , India . Participants 2079 low birthweight infants born at term ( > 37 weeks ’ gestation ) . Main outcome measures Primary outcome was admission to hospital or death during the first six months of life . Main secondary outcome was growth . Interventions Weekly vitamin D supplements for six months at a dose of one recommended nutrient intake per day ( 35 µg/week ) . Infants were visited weekly at home for observed supplementation and were brought to the clinic monthly for clinical examination and anthropometric measurements . Results Between group differences were not significant for death or hospital admissions ( 92 among 1039 infants in the vitamin D group v 99 among 1040 infants in the placebo group ; adjusted rate ratio 0.93 , 95 % confidence interval 0.68 to 1.29 ; P=0.68 ) , or referral to the outpatient clinic for moderate morbidity  . Vitamin D supplementation result ed in better vitamin D status as assessed by plasma calcidiol levels at six months . In adjusted analyses , vitamin D treatment significantly increased st and ard deviation ( z ) scores at six months for weight , length , and arm circumference and decreased the proportion of children with stunted growth ( length for age z score ≤2 ) or with arm circumference z scores of 2 or less . Conclusion A weekly dose of vitamin D result ed in better vitamin D status and benefited the classic vitamin D function of bone growth but did not decrease the incidence of severe morbidity or death among young low birthweight infants . Trial registration Clinical Trials.gov NCT00415402 Background : Poor vitamin D status , i.e. low serum levels of 25-hydroxyvitamin D [ 25(OH)D ] , is common in the general population . Prospect i ve epidemiologic data on the association between vitamin D and mortality in oldest old subjects are limited . Objective : This study aim ed to determine whether 25(OH)D concentrations were prospect ively and independently associated with cardiovascular disease ( CVD ) mortality and all-cause mortality in oldest old subjects . Methods : A total of 312 subjects aged 85 years old at baseline ( Octabaix study ) were followed for 3 years . Sociodemographic and overall geriatric assessment data were collected . Serum 25(OH)D concentrations were used to assess vitamin D status . Data on overall and cardiovascular mortality were collected . Results : The mean serum 25(OH)D levels were 28 ± 30 ng/ml . During the follow-up period , 58 subjects ( 18.5 % ) died . Twenty-five of the deaths ( 8 % ) were related to CVD . There were no differences in mortality rates according to the different quartiles of vitamin D ( p = 0.41 for total mortality and p = 0.86 for CVD mortality ) . Conclusion : In community-dwelling oldest old subjects  , serum 25(OH)D levels were not associated with overall or CVD mortality after a 3-year follow-up Purpose To investigate the association between serum 25-hydroxyvitamin D [ 25(OH)D ] concentration , a marker of vitamin D status , and risk of all-cause and cardiovascular mortality in a general older population with relatively low average serum 25(OH)D concentrations . Methods The study population included 552 men and 584 women aged 53–73 years who were free of CVD and cancer at baseline in 1998–2001 from the prospect i ve , population -based Kuopio Ischaemic Heart Disease Risk Factor ( KIHD ) Study . Deaths were ascertained by a computer linkage to the national cause of death register . All deaths that occurred from the study entry to December 31 , 2008 , were included . Cox proportional hazards regression models were used to analyze the association between serum 25(OH)D and risk of death . Results The mean serum 25(OH)D concentration was 43.7 nmol/L ( SD 17.8 ) , with a strong seasonal variation . During the average follow-up of 9.1 years , 87 participants died , 35 from cardiovascular disease ( CVD ) . After multivariable-adjustments , the hazard ratios ( HR ) for all cause death in the tertiles of serum 25(OH)D were 1 , 1.68 ( 95 % CI : 0.92 , 3.07 ) and 2.06 ( 95 % CI : 1.12 , 3.80 ) , p for trend = 0.02 . Conclusions Our study supports the accumulating evidence from epidemiological studies that vitamin D deficiency is associated with increased risk of death . Large-scale primary prevention trials with vitamin D supplementation are warranted Accumulating evidence suggests that vitamin D may protect against cancer , but results from epidemiologic studies are inconclusive so far , and other studies looking into the prospect i ve association of total cancer mortality and serum 25-hydroxyvitamin D [ 25(OH)D ] levels , which are considered to be the best indicator of vitamin D status , are scarce . We measured 25(OH)D and 1,25-dihydroxyvitamin D in 3,299 patients from the Ludwigshafen Risk and Cardiovascular Health study . The baseline examination was done between July 1997 and January 2000 and included a fasting blood sampling in the morning before coronary angiography . During a median follow-up period of 7.75 years , 95 patients died due to cancer . After adjustment for possible confounders , the Cox proportional hazard ratio ( 95 % confidence interval ) of the fourth 25(OH)D quartile was 0.45 ( 0.22 - 0.93 ) when compared with the first quartile and the hazard ratio per increase of 25 nmol/L in serum 25(OH)D concentrations was 0.66 ( 0.49 - 0.89 ) . We found no association between serum 1,25-dihydroxyvitamin D levels and fatal cancer . In summary , our data suggest that low levels of 25(OH)D are associated with increased risk of fatal cancer in patients referred to coronary angiography and that the maintenance of a sufficient vitamin D status might therefore be a promising approach for the prevention and /or treatment of cancer . ( Cancer Epidemiol Biomarkers Prev 2008;17(5):1228–33 Globally , cardiovascular disease ( CVD ) is the number one cause of death , being responsible for approximately 30 % of deaths worldwide . Urbanization and a westernized lifestyle are thought to play a major role in the development of CVD . There is accumulating evidence that vitamin D is a nonclassical risk factor for CVD . The active vitamin D metabolite , 1,25-dihydroxyvitamin D , which is synthesized from its precursor 25-hydroxyvitamin D ( 25[OH]D ) , down-regulates several negative and up-regulates various protective pathways in the heart and vasculature . First r and omized trials demonstrate that vitamin D supplementation leads to vasodilatation and suppresses cardiovascular risk markers such as triglycerides and the inflammation marker tumor necrosis factor-α . Solar UV-B radiation is the major source of vitamin D for humans . Consequently , the vitamin D status is largely influenced by season , geographic latitude , daily outdoor activities , and the percentage of body surface exposed to solar UV-B. A significant proportion of individuals in Europe and North America have  vitamin D concentrations in the deficiency range ( 25[OH]D<25 nmol/l ) . Available data indicate that low solar UV-B exposure and /or low 25(OH)D concentrations are associated with an increased risk of CVD . Large nonr and omized studies indicate that CVD mortality is more than twice as high in older individuals with deficient 25(OH)D concentrations compared with those individuals who have adequate 25(OH)D concentrations ( > 75 nmol/l ) . Together , experimental and epidemiological evidence does support a plausible role for improving vitamin D status in CVD prevention in the population at large . Nevertheless , future r and omised clinical trials are needed to evaluate whether vitamin D is effective with respect to primary , secondary , and /or tertiary prevention of CVD BACKGROUND / OBJECTIVES : Although both frailty and low vitamin D have been separately associated with an increased risk for adverse health , their joined effects on mortality have not been reported . The current study examined prospect ively the effects of frailty and vitamin D status on mortality in US older adults . SUBJECTS/ METHODS : Participants aged ⩾60 years in The Third National Health and Nutrition Examination Survey with 12 years of mortality follow-up were included in the analysis ( n=4731 ) . Frailty was defined as meeting three or more criteria and pre-frailty as meeting one or two of the five frailty criteria ( low body mass index ( BMI ) , slow walking , weakness , exhaustion and low physical activity )  . Vitamin D status  was assessed by serum 25-hydroxyvitamin D ( 25(OH)D )  and categorized into quartiles . Analyses were adjusted for gender , race , age , smoking , education , latitude and other comorbid conditions . RESULTS : Serum 25(OH)D concentrations were lowest in participants with frailty , intermediate in participants with pre-frailty and highest in participants without frailty . The odds of frailty in the lowest quartile of serum 25(OH)D was 1.94 times the odds in the highest quartile ( 95 % confidence interval ( CI ) : 1.09–3.44 ) . Mortality was positively associated with frailty , with the risk among participants who were frail and had low serum 25(OH)D being significantly higher than those who were not frail and who had high concentrations of serum 25(OH)D ( hazards ratio 2.98 ; 95 % CI : 2.01–4.42 ) . CONCLUSION : Our results suggest that low serum 25(OH)D is associated with frailty , and there is additive joint effects of serum 25(OH)D and frailty on all-cause mortality in older adults Background Several studies have shown an association between vitamin D deficiency and cardiovascular risk . Vitamin D status is assessed by determination of 25-hydroxyvitamin D [ 25(OH)D ] in serum . Methods We assessed the prognostic utility of 25(OH)D in 982 chest-pain patients with suspected acute coronary syndrome ( ACS ) from Salta , Northern Argentina . 2-year follow-up data including all-cause mortality , cardiac death and sudden cardiac death were analyzed in quartiles of 25(OH)D , applying univariate and multivariate analysis . Results There were statistically significant changes in seasonal 25(OH)D levels . At follow-up , 119 patients had died . The mean 25(OH)D levels were significantly lower among patients dying than in long-term survivors , both in the total population and in patients with a troponin T ( TnT ) release ( n = 388 ) . When comparing 25(OH)D in the highest quartile to the lowest quartile in a multivariable Cox regression model for all-cause mortality , the hazard ratio ( HR ) for cardiac death and sudden cardiac death in the total population was 0.37 ( 95 % CI , 0.19–0.73 ) , p = 0.004 , 0.23 ( 95 % CI , 0.08–0.67 ) , p = 0.007 , and 0.32 ( 95 % CI , 0.11–0.94 ) , p = 0.038 , respectively . In patients with TnT release , the respective HR was 0.24 ( 95 % CI , 0.10–0.54 ) , p = 0.001 , 0.18 ( 95 % CI , 0.05–0.60 ) , p = 0.006 and 0.25 ( 95 % CI , 0.07–0.89 ) , p = 0.033 . 25(OH)D had no prognostic value in patients with no TnT release . Conclusion Vitamin D was shown to be a useful biomarker for prediction of mortality when obtained at admission in chest pain patients with suspected ACS . Trial registration Clinical Trials.gov
Vitamin D in the form of vitamin D(3 ) seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent care .
Vitamin D(2 ) , alfacalcidol , and calcitriol had no statistically significant effect on mortality .
Vitamin D(3 ) combined with calcium significantly increased nephrolithiasis .
Both alfacalcidol and calcitriol significantly increased hypercalcaemia
BACKGROUND The available evidence on vitamin D and mortality is inconclusive .
OBJECTIVES To assess the beneficial and harmful effects of vitamin D for prevention of mortality in adults .