Dietary vitamin D intake, cardiovascular disease and cardiometabolic risk factors: a sex‐based analysis from the ATTICA cohort study
Kouvari M, Panagiotakos D B, Chrysohoou C et al.
The present study aimed to evaluate the association between dietary vitamin D intake and 10‐year first fatal/nonfatal cardiovascular disease (CVD), conventional CVD risk factors and surrogate markers related to inflammation, coagulation, insulin resistance, liver and renal function.
The ATTICA study was conducted during 2001–2012 including 1514 men and 1528 women (aged >18 years) from the greater Athens area, Greece. Dietary assessment was based on a validated semi‐quantitative food frequency questionnaire. Daily intake of vitamin D was calculated using a standardised food database. Follow‐up (2011–2012) was achieved in 2020 participants (n = 317 cases).
Ranking from first to third vitamin D tertile, CVD events were 24%, 17% and 12% for men (P = 0.002) and 14%, 10% and 11% for women (P = 0.59). Inverse associations between vitamin D and CVD in total sample [hazard ratio (HR) = 0.76 95% confidence interval (CI) = 0.60–0.97] and in men (HR = 0.66 95% CI = 0.49–0.89) were observed, and lost after adjusting for inflammation/coagulation markers; for women, no significant trends were observed. Regarding 10‐year onset of conventional risk factors, inverse associations of vitamin D with hypertension in men (HR = 0.62 95% CI = 0.39–0.99) and transition to metabolically unhealthy status in women (HR = 0.69 95% CI = 0.51–0.93) were observed. Significant inverse associations for C‐reactive protein, interleukin‐6 and fibrinogen in both sexes, whereas these were revealed only in women for insulin resistance.
Contradicting the neutral/modest associations in vitamin‐D supplementation trials, increased food‐generated vitamin D may protect against hard and intermediate CVD endpoints, implying different paths between sexes.