Louise Lind Schierbeck, Lars Rejnmark, Charlotte Landbo Tofteng, Lis Stilgren, Pia Eiken, Leif Mosekilde, Lars Køber and Jens-Erik Beck Jensen
To investigate the relationship between vitamin D status in healthy women and cardiovascular outcome.
Design and methods
Between 1990 and 1993, 2016 healthy, recently postmenopausal women were enrolled in the Danish Osteoporosis Prevention Study. Serum levels of 25-hydroxyvitamin D (25(OH)D, nmol/l) were measured at baseline. Participants were followed for 16 years. The primary end point was a combination of death, heart failure, myocardial infarction (MI) and stroke. Vitamin D deficiency was defined as serum 25(OH)D<50 nmol/l. The primary end point was adjusted for other risk factors of adverse cardiovascular events (age, smoking, blood pressure, hip–waist ratio, education and family history of MI).
At baseline, mean age was 50 years and BMI 25. Women with vitamin D deficiency (n=788) had more cardiovascular risk factors than vitamin D-replete women (n=1225). Compared with vitamin D-replete women, women with low 25(OH)D levels had significantly higher BMI and triglycerides, lower HDL and hip–waist ratio and less education. More were smokers among the vitamin D deficient (47 vs 38%). A primary end point was experienced by 118 (15%) with vitamin D deficiency and by 125 (10%) of the vitamin D replete. Hazard ratio (HR) was 1.49 (95% confidence interval: 1.16–1.92; P=0.002) in the vitamin D deficient. Adjusted HR was 1.32 (1.02–1.71; P=0.03). In total, 135 women died; of these, 65 (8%) were of the vitamin D deficient and 70 (6%) in the vitamin D-replete group; unadjusted HR was 1.44 (1.02–2.01; P=0.04) for vitamin D deficiency.
Healthy women with vitamin D deficiency have increased risk of adverse cardiovascular outcome.
Charlotte Andersson, Peter Søgaard, Søren Hoffmann, Peter R Hansen, Allan Vaag, Atheline Major-Pedersen, Thomas Fritz Hansen, Jan Bech, Lars Køber, Christian Torp-Pedersen and Gunnar H Gislason
To examine the association between selected glucose-lowering medications and left ventricular (LV) diastolic function in patients with diabetes.
Retrospective cohort study (years 2005–2008).
Echocardiograms of 242 patients with diabetes undergoing coronary angiography were analyzed. All patients had an LV ejection fraction (LVEF) ≥20% and were without atrial fibrillation, bundle branch block, valvular disease, or cardiac pacemaker. Patients were grouped according to the use of metformin (n=56), sulfonylureas (n=43), insulin (n=61), and combination treatment (n=82).
Mean age (66±10 years) and mean LVEF (45±11%) were similar across the groups. Mean isovolumic relaxation time (IVRT) was 66±31, 79±42, 69±23, and 66±29 ms in metformin, sulfonylureas, insulin, and combination treatment groups respectively (P=0.4). Mean early diastolic longitudinal tissue velocity (e′) was 5.3±1.6, 4.6±1.6, 5.3±1.8, and 5.4±1.7 cm/s in metformin, sulfonylureas, insulin, and combination treatment groups (P=0.04). In adjusted linear regression models, the use of metformin was associated with a shorter IVRT (parameter estimate −9.9 ms, P=0.049) and higher e′ (parameter estimate +0.52 cm/s, P=0.03), compared with no use of metformin. The effects of metformin were not altered by concomitant use of sulfonylureas or insulin (P for interactions >0.4).
The use of metformin is associated with improved LV relaxation, as compared with no use of metformin.