Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 57; no. 9; pp. 1595 - 1603
• Main Authors: Ginde, Adit A., Scragg, Robert, Schwartz, Robert S., Camargo Jr, Carlos A.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.09.2009; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Biological and medical sciences; Cardiovascular disease; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; Cause of Death; Cohort Studies; Comorbidity; Epidemiology; Female; Follow-Up Studies; General aspects; geriatrics; Humans; Male; Medical sciences; Miscellaneous; Mortality; Nutrition Surveys; Older people; Proportional Hazards Models; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; United States; Vitamin D; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - mortality; USA; Human; Steroid hormone; Mortality; Cardiovascular disease; Epidemiology; Gerontology; Vitamin D; Follow up study; Clinical biology; Cause; Cholecalciferol(25-hydroxy); Adult; Elderly; Age; Public health; Geriatrics
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/j.1532-5415.2009.02359.x

OBJECTIVES: To evaluate the association between serum 25‐hydroxyvitamin D (25(OH)D) levels and mortality in a representative U.S. sample of older adults. DESIGN: Prospective cohort from the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality files. SETTING: Noninstitutionalized U.S. civilian population. PARTICIPANTS: Three thousand four hundred eight NHANES III participants aged 65 and older enrolled from 1988 to 1994 and followed for mortality through 2000. MEASUREMENTS: Primary exposure was serum 25(OH)D level at enrollment. Primary and secondary outcomes were all‐cause and cardiovascular disease (CVD) mortality, respectively. RESULTS: During the median 7.3 years of follow‐up, there were 1,493 (44%) deaths, including 767 CVD‐related deaths. Median 25(OH)D level was 66 nmol/L. Adjusting for demographics, season, and cardiovascular risk factors, baseline 25(OH)D levels were inversely associated with all‐cause mortality risk (adjusted hazard ratio (HR)=0.95, 95% confidence interval (CI)=0.92–0.98, per 10 nmol/L 25[OH]D). Compared with subjects with 25(OH)D levels of 100 nmol/L or higher, the adjusted HR for subjects with levels less than 25.0 nmol/L was 1.83 (95% CI=1.14–2.94) and for levels of 25.0 to 49.9 nmol/L was 1.47 (95% CI=1.09–1.97). The association appeared stronger for CVD mortality (adjusted HR=2.36, 95% CI=1.17–4.75, for subjects with 25[OH]D levels<25.0 nmol/L vs those ≥100.0 nmol/L) than for non‐CVD mortality (adjusted HR=1.42, 95% CI=0.73–2.79, for subjects with 25[OH]D levels<25.0 nmol/L vs those ≥100.0 nmol/L). CONCLUSION: In noninstitutionalized older adults, a group at high risk for all‐cause mortality, serum 25(OH)D levels had an independent, inverse association with CVD and all‐cause mortality. Randomized controlled trials of vitamin D supplementation in older adults are warranted to determine whether this association is causal and reversible.