Vitamin D and progression of carotid intima‐media thickness in HIV‐positive Canadians
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abstract
ObjectivesBased on a growing body of evidence implicating low vitamin D status in the development of cardiovascular disease (CVD), we hypothesized that in Canadian HIV‐positive adults, low 25‐hydroxyvitamin D (25(OH)D) concentration would be associated with increased subclinical vascular disease progression.MethodsWe prospectively studied the relationship between baseline 25(OH)D and subsequent progression of carotid intima‐media thickness (CIMT) between 2002 and 2011, in the Canadian HIV Vascular Study using stored blood specimens.ResultsOf the 128 participants, 89.1% were men, the mean age (standard deviation [SD]) was 46.5 (8.2) years, 93.8% were white, and 36.7% were current smokers. Mean (SD) annual CIMT follow‐up was 5.9 (1.8) years (maximum 8.5 years), providing approximately 750 patient‐years of follow‐up. Mean (SD) CIMT progression was 0.027 (0.030) mm/year. Mean (SD) 25(OH)D was 95.0 (46.9) nmol/L. Only 13.3% of participants were vitamin D deficient (25(OH)D < 50 nmol/L), whereas 61.7% had a 25(OH)D exceeding the sufficiency threshold (75 nmol/L). Vitamin D quartiles were inversely associated with body mass index (BMI) (P = 0.034), total cholesterol to high‐density lipoprotein (HDL) cholesterol ratio (P = 0.001) and parathyroid hormone concentration (P = 0.003), but not efavirenz exposure (P = 0.141). In linear regression analyses, baseline 25(OH)D as a continuous variable was inversely associated with CIMT progression in univariable (P < 0.001) and multivariable (P < 0.001) models.ConclusionsBaseline 25(OH)D was associated with CIMT progression in this relatively vitamin D replete, predominately white and male, Canadian HIV‐positive population. Future research needs to establish causality as this may warrant more targeted screening or supplementation.
