Kidney Week

Abstract: SA-PO185

The Vitamin D Metabolite Ratio and Coronary Artery Calcification in the Multi-Ethnic Study of Atherosclerosis

Session Information

• Vascular Calcification, Nephrolithiasis, Bone
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Ginsberg, Charles, University of California San Diego, La Jolla, California, United States

Charles Ginsberg,

• Hoofnagle, Andrew N., University of Washington, Seattle, Washington, United States

Andrew N. Hoofnagle,

• Katz, Ronit, University of Washington, Seattle, Washington, United States

Ronit Katz,

• Cheng, Jonathan, University of California San Diego, La Jolla, California, United States

Jonathan Cheng,

• Hsu, Simon, University of Washington, Seattle, Washington, United States

Simon Hsu,

• Budoff, Matthew Jay, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States

Matthew Jay Budoff,

• Kado, Deborah M., Stanford Medicine, Stanford, California, United States

Deborah M. Kado,

• Kestenbaum, Bryan R., University of Washington, Seattle, Washington, United States

Bryan R. Kestenbaum,

• Michos, Erin D., Johns Hopkins University, Baltimore, Maryland, United States

Erin D. Michos,

• Siscovick, David, University of Washington, Seattle, Washington, United States

David Siscovick,

• Ix, Joachim H., University of California San Diego, La Jolla, California, United States

Joachim H. Ix,

• de Boer, Ian H., University of Washington, Seattle, Washington, United States

Ian H. de Boer,

Background

Studies examining the relationship between 25(OH)D deficiency and coronary artery calcification (CAC) are conflicted. The vitamin D metabolite ratio (VMR) (ratio of 24,25(OH)₂D₃ to 25(OH)D₃) is more strongly associated with fracture and mortality risk and may be a superior marker of vitamin D adequacy compared to 25(OH)D. The relationship of the VMR with CAC remains unknown.

Methods

We measured vitamin D metabolites using liquid chromatography mass-spectroscopy in 5,945 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC was measured at baseline and then again annually through year 5. We assessed the relationship of the 25(OH)₃D and the VMR with CAC prevalence (Agatston scores of >0), severity, and incidence (Agatston scores of >0 in follow-up). We used logistic, linear and Poisson regression to evaluate these associations in models adjusting for demographics, season physical activity, BMI, smoking, diabetes, blood pressure, C-reactive protein, cholesterol levels, eGFR, urine albumin to creatinine ratio (ACR), serum calcium, phosphate, PTH and FGF-23.

Results

The mean age was 62 ± 10 years, 54% were women and the median (IQR) 25(OH)D₃ and VMR were 21(15, 30)ng/ml and 15.0(12.3, 18.1)(ng/ml / ng/ml), respectively. The mean eGFR was 79 ± 18 ml/min/1.73m² and 10% had an eGFR< 60 ml/min/1.73m². 2,985 participants had prevalent CAC at baseline. In minimally and fully adjusted models, there was no statistical association of 25(OH)D₃ or the VMR with CAC prevalence or severity. Among 2,090 persons without CAC at baseline and follow-up CAC imaging, neither 25(OH)D₃ nor the VMR were associated or the development of incident CAC in follow-up (Table).

Conclusion

Among a large sample of community-living individuals without clinically apparent cardiovascular disease, 25(OH)D₃ and the VMR were not associated with prevalence, severity or incidence of CAC. While prior studies associate a low VMR with an increased mortality, it appears unlikely that this risk is mediated through development of CAC.

Table 1: Association of 25(OH)D3 and the VMR with CAC Among MESA Participants

Funding

• NIDDK Support