Abstract:

Objectives: Vitamin D plays a role in the cardiovascular system through its pleomorphic effects. In some studies, it has been reported that the relationship between vitamin D deficiency and coronary artery calcification is inconsistent. In this study, it was aimed to evaluate the relationship between the vitamin D level and coronary artery calcium score (CACS), plaque presence, and plaque type. Materials and Methods: Included in this retrospective cohort study were 719 patients who had no previously known coronary artery disease (CVD), and for whom coronary computed tomography angiography (CCTA) was performed between 2015 and 2019. Patients were classified as normal, inadequate, or deficient according to their levels of vitamin D deficiency. They were evaluated according to the presence of plaque on their CCTA or CACS >0 atherosclerosis. Moreover, patients were separated into four groups, comprising zero-plaque (those that were not plaque according to the plaque type), mere fatty plaque (CACS=0), mere calcified plaque, and mixed plaque. Age, sex, smoking status, diabetes mellitus, hypertension, and hyperlipidemia were evaluated as traditional risk factors. Results: In 18.4% of the patients, the vitamin D levels were normal, whereas they were inadequate in 65% and deficient in 16.7%. The median CACS of the patients was 0 (range: 0-3759), and mere fatty plaque was found in 13.5% of patients, whereas 13.4% had mere calcified plaque, and 27.5% had mixed plaque. A negative correlation was detected between the vitamin D levels and CACSs (r=0.345; p<0.001). The median CACS in those with vitamin D deficiency was higher when compared to those with inadequate and normal levels (normal: 0 vs inadequate: 0 vs deficient: 7; p<0.001). Regardless of the traditional risk factors, vitamin D deficiency was found to be an independent predictor of atherosclerosis [odds ratio (OR): 6.9; 95% confidence interval (CI): 3.53-13.52; p<0.001], fatty plaque (OR: 3.04; 95% CI: 1.34-6.87; p=0.008), mere calcified plaque (OR: 13.11; 95% CI: 3.53-13.52; p<0.001), and mixed plaque (OR: 14.27; 95% CI: 5.58-36.50; p<0.001). Moreover, regardless of the traditional risk factors, the vitamin D deficiency increased the risk of fatty plaque development by 2.37 times in patients with CACS: 0 (OR: 2.37; 95% CI: 1.01-5.62; p=0.045). Conclusion: A decrease in vitamin D level is associated with an increase in the CACS, and the development of calcified and mixed plaque is more likely when there is vitamin D deficiency. Depending on the incidence of CVDs and vitamin D deficiency in asymptomatic patients, vitamin D supplements can be beneficial.

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