A study of vitamin d levels in patients presenting with acute coronary syndromes

Introduction: Vitamin D deficiency is highly prevalent worldwide, and is also noted to be high in India. Low levels of 25(OH) D, the principle circulating storage form of vitamin D, is present in as many as one third to one half of otherwise healthy middle aged to elderly population. Vitamin D, known primarily as a factor of bone metabolism, can affect the transcription of a number of genes, which play a vital role in the development of ACS and pathogenesis of CAD. The vitamin D axis affects vascular smooth muscle cell proliferation, inflammation, vascular calcification, the renin-angiotensin system (RAS), and blood pressure, all of which affect risk of CVD and myocardial infarction (MI). Endothelial dysfunction plays an important role in pathogenesis of CAD and vitamin D deficiency is postulated to promote endothelial dysfunction Because hypovitaminosis D is prevalent and easily correctable, establishing the relationship between vitamin D and risk of MI is important. Objectives: 1. To assess the levels of Vitamin D in patients with acute coronary syndromes. 2. To elucidate a possible correlation between the levels of Vitamin D in patients with acute coronary syndromes. Methods: A prospective study of 50 patients admitted in Basaveshwar Hospital, Kalaburagi with acute coronary syndromes were studied between December 2013 and May 2015. The Vitamin D levels were analyzed in all the patients and correlated with different parameters for statistical significance. Results: The mean age of the study group was 57.96±9.6 years. Of the 50 patients, 28 were males with a male: female ratio of 1.2:1. Our study group had 17 patients who had a smoking history and 15 who consumed alcohol. AWMI was the most common presentation that was observed in 20/50 patients and NSTEMI was seen least in 9/50 patients. Vitamin D deficiency was seen in 78% of patients with acute coronary syndrome. 26 patients had Vitamin D deficiency levels (<20 ng/ml) while 13 patients had insufficiency (vitamin D levels 21-30 ng/ml). 57.7% of females had Vitamin D deficiency. This was significant when compared to the male population. Vitamin D deficient patients had a higher incidence of diabetes (57.69%) and hypertension (69.23%). Contrary to many studies, we could not elicit any significant association between total cholesterol levels or triglyceride levels. One patient in our study expired within 24 hours. He had an AWMI who presented in cardiogenic shock. His Vitamin D level was 20.2 ng/ml. Conclusions: There is a high prevalence of Vitamin D deficiency (78%) among ACS patients. Vitamin D deficiency, along with increasing the prevalence of traditional risk factors for ACS, might also be an independent risk factor for ACS.