Akut koroner sendromlu hastalarda vitamin d düzeyleri

Abstract

Acute coronary syndrome (ACS) is a common cause of morbidity and mortality, especially in developed and developing countries. Recent studies showed that vitamin D deficiency associates with increased risk for cardiovascular events, but the mechanism driving this association is unknown. Several mechanisms might be responsible for a protective role of vitamin D in CVD. These mechanisms include the inhibition of vascular smooth muscle proliferation, the suppression of vascular calcification, the down regulation of pro-inflammatory cytokines and biosynthesis of renin. Additionally, vitamin D deficiency causes an increases insulin resistance and is associated with diabetes, hypertension, inflammation and increased cardiovascular risk. The aim of this study was, to investigate the association between acute coronary syndrome and the plasma 25(OH)D and PTH levels. In this study, we enrolled 50 patients with the diagnosis of ACS and 50 control individuals who were hospitalized in the cardiology department of the PUTF. Patients enrolled from February 1 2012 to January 31, 2013 . The age of participants were between 41 - 74 years. We found the mean plasma 25(OH)D levels were significantly different between patients with ACS and controls (median: 14,77 + 7,88 vs. 23,48 + 10,82 ng / mL, respectively, P = 0,001). After adjustment for hyperlipidemia, smoking status, hypertension, diabetes, participants with 25(OH)D deficiency had an increased risk of prevalance of ACS (odds ratio 17,96). In this study we found, vitamin D levels were significantly lower in patients with ACS compared with patients with normal coronary arteries independent of seasonal fluctuation. Despite PTH levels were higher in ACS group; this result did not reach statistical significance. These results indicate a strong and independent relationship of 25(OH)D deficiency with the prevalance of ACS . AKS’ ler, halen gelişmiş ve gelişmekte olan ülkelerde erişkin yaştaki bireylerde mortalite ve morbiditenin en önemli sebebidir. ABD’ de 2009 yılına ait ölüm verileri incelendiğinde 386,324 kişinin koroner arter hastalığından (KAH) dolayı hayatını kaybettiği saptanmıştır. Her yıl tahmini 635,000 Amerikalı ilk kez akut miyokart infarktüsü (AMI) yada KAH tanısıyla hastanelere yatarken , yaklaşık 280,000 kişi tekrarlayan ataklarla hastanelere yatmaktadır. Ek olarak her yıl 150,000 Amerikalı ilk kez sessiz miyokart infarktüsü (Mİ) geçirmektedir. Yaklaşık her 34 saniyede bir Amerikalı akut koroner olay geçirmekte ve her dakika bir Amerikalı yaşamını bu nedenle kaybetmektedir (1). Ülkemizde Tekharf çalışmasının 2009 yılı verilerini incelediğimizde, tüm Türkiye genelinde yaklaşık 3,1 milyon koroner kalp hastasının bulunduğu, her yıl bu sayıya 200,000 kişinin eklendiği ve 90,000’ i ölümcül olmak üzere her yıl toplam 390,000 kişide yeni koroner olaylar meydana geldiği bildirilmektedir (2). Acute coronary syndrome (ACS) is a common cause of morbidity and mortality, especially in developed and developing countries. Recent studies showed that vitamin D deficiency associates with increased risk for cardiovascular events, but the mechanism driving this association is unknown. Several mechanisms might be responsible for a protective role of vitamin D in CVD. These mechanisms include the inhibition of vascular smooth muscle proliferation, the suppression of vascular calcification, the down regulation of pro-inflammatory cytokines and biosynthesis of renin. Additionally, vitamin D deficiency causes an increases insulin resistance and is associated with diabetes, hypertension, inflammation and increased cardiovascular risk. The aim of this study was, to investigate the association between acute coronary syndrome and the plasma 25(OH)D and PTH levels. In this study, we enrolled 50 patients with the diagnosis of ACS and 50 control individuals who were hospitalized in the cardiology department of the PUTF. Patients enrolled from February 1 2012 to January 31, 2013 . The age of participants were between 41 - 74 years. We found the mean plasma 25(OH)D levels were significantly different between patients with ACS and controls (median: 14,77 + 7,88 vs. 23,48 + 10,82 ng / mL, respectively, P = 0,001). After adjustment for hyperlipidemia, smoking status, hypertension, diabetes, participants with 25(OH)D deficiency had an increased risk of prevalance of ACS (odds ratio 17,96). In this study we found, vitamin D levels were significantly lower in patients with ACS compared with patients with normal coronary arteries independent of seasonal fluctuation. Despite PTH levels were higher in ACS group; this result did not reach statistical significance. These results indicate a strong and independent relationship of 25(OH)D deficiency with the prevalance of ACS .