Context:Vitamin D deficiency patients have an increased cardiovascular (CV) morbidity and mortality. Carotid intima-media thickness (IMT) and carotid plaques are markers of subclinical atherosclerosis and predictors of CV events. Objective:To perform a meta-analysis of studies evaluating the impact of Vitamin D deficiency on common carotid artery IMT (CCA-IMT) and on the prevalence of carotid plaques. Data Sources:Studies were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Results:Twenty-one studies (3,777 Vitamin D deficiency patients and 4,792 controls) with data on CCA-IMT and 6 studies (1,889 Vitamin D deficiency patients and 2,883 controls) on the prevalence of carotid plaques were included. Compared to controls, Vitamin D deficiency patients showed a significantly higher CCA-IMT (mean difference [MD]: 0.043 mm; 95%CI: 0.030, 0.056; P<0.001), and an increased prevalence of carotid plaques (Odds Ratio [OR]: 2.29, 95%CI: 1.03-5.11; P=0.043) with an attributable risk of 35.9%. When selecting studies specifically including patients with diabetes, the prevalence of carotid plaques in Vitamin D deficiency patients than in controls resulted higher (OR: 3.27; 95%CI: 1,62-6.62; P=0.001). A significant difference in CCA-IMT was confirmed when comparing patients with Vitamin D insufficiency to controls (MD: 0.011; 95%CI: 0.010-0.012, P<0.001). Sensitivity analyses substantially confirmed results and regression models showed that with the exception of LDL-cholesterol, HDL-cholesterol, triglycerides and the prevalence of hypercholesterolemia, all the other clinical and demographic co-variates significantly impacted on the difference in CCA-IMT between Vitamin D deficiency patients and controls. Conclusions:Both Vitamin D deficiency and Vitamin D insufficiency are associated with subclinical atherosclerosis, potentially suggesting an increased CV risk in these clinical settings.

译文

背景:维生素D缺乏症患者的心血管(CV)发病率和死亡率增加。颈动脉内膜中层厚度(IMT)和颈动脉斑块是亚临床动脉粥样硬化的标志物和CV事件的预测因子。
目的:进行荟萃分析,评估维生素D缺乏对颈总动脉IMT(CCA-IMT)和颈动脉斑块患病率的影响。
数据来源:在PubMed,Web of Science,Scopus和EMBASE数据库中系统地搜索了研究。
结果:包括21项研究(3,777例维生素D缺乏症患者和4,792例对照者)的CCA-IMT数据和6项研究(1,889例D维生素D缺乏症患者和2,883例对照者)的颈动脉斑块患病率。与对照组相比,维生素D缺乏症患者的CCA-IMT显着更高(平均差异[MD]:0.043毫米; 95%CI:0.030,0.056; P <0.001),并且颈动脉斑块的患病率增加(几率[OR] ]:2.29,95%CI:1.03-5.11; P = 0.043),归因风险为35.9%。在选择专门针对糖尿病患者的研究时,维生素D缺乏症患者的颈动脉斑块患病率高于对照组(OR:3.27; 95%CI:1,62-6.62; P = 0.001)。当将维生素D功能不足的患者与对照组进行比较时,证实了CCA-IMT的显着差异(MD:0.011; 95%CI:0.010-0.012,P <0.001)。敏感性分析基本证实了结果,回归模型显示,除了低密度脂蛋白胆固醇,高密度脂蛋白胆固醇,甘油三酸酯和高胆固醇血症的患病率外,所有其他临床和人口统计学共同变量均显着影响维生素D之间CCA-IMT的差异缺乏患者和对照。
结论:维生素D缺乏症和维生素D缺乏症均与亚临床动脉粥样硬化有关,可能提示在这些临床情况下CV风险增加。

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