Low Vitamin D Ups Coronary Artery Disease Risk in HIV+ US Blacks

Vitamin D deficiency more than doubled the risk of silent coronary artery disease (CAD) in HIV-positive African Americans, according to results of a 674-person study.

Research suggests that vitamin D deficiency is associated with CAD, and cardiovascular disease has become more prevalent as HIV-positive people survive longer thanks to combination antiretroviral therapy (ART). But the impact of vitamin D deficiency on CAD in HIV-positive African Americans had not been characterized until this study of 25- to 54-year-old HIV-positive African Americans in Baltimore, Maryland.

The investigators used computed tomographic (CT) coronary angiography to assess coronary stenosis (narrowing) in study participants without symptoms or clinical evidence of CAD. The researchers defined significant coronary stenosis as 50% or greater blockage. They defined vitamin D deficiency as a 25-hydroxy vitamin D level below 10 ng/mL.

Twenty percent of study participants (95% confidence interval [CI] 16.9 to 23.1) had vitamin D deficiency, and 64 (9.5%) had significant coronary stenosis.

Multiple logistic regression analysis identified 6 factors that independently raised the odds of significant stenosis, at the following adjusted odds ratios (aOR) (and 95% CIs):

• Vitamin D deficiency: aOR 2.28 (1.23 to 4.21)

• Male gender: aOR 2.19 (1.17 to 4.10)

• Diastolic blood pressure ≥85 mmHg: aOR 1.94 (1.02 to 3.68)

• Low-density lipoprotein cholesterol ≥100 mg/dL: aOR 1.95 (1.13 to 3.36)

• Cocaine use for ≥15 years: aOR 1.77 (1.01 to 3.10)

• ART for ≥6 months: aOR 2.26 (1.17 to 4.36)

More recent enrollment in the study group lowered the risk of significant stenosis:

• Enrollment in 2006-2007 vs before: aOR 0.32 (0.13 to 0.76)

• Enrollment in 2008-2009 vs before 2006: aOR 0.26 (0.12 to 0.56)

• Enrollment in 2010 vs before 2006: aOR 0.32 (0.15 to 0.65)

“Both vitamin D deficiency and silent CAD are prevalent in HIV-infected African Americans,” the researchers conclude. “In addition to management of traditional CAD risk factors and substance abuse,” they advise, “vitamin D deficiency should be evaluated in HIV-infected African Americans.”

Source: Hong Lai, Gary Gerstenblith, Elliot K. Fishman, Jeffrey Brinker, Thomas Kickler, Wenjing Tong, Sundeepan Bhatia, Tai Hong, Shaoguang Chen, Ji Li, Barbara Detrick, Shenghan Lai. Vitamin D deficiency is associated with silent coronary artery disease in cardiovascularly asymptomatic African Americans with HIV infection. Clinical Infectious Diseases. 2012; 54: 1747-1755.

For the study abstract (Downloading the complete article requires a subscription to Clinical Infectious Diseases or an online payment; the abstract is free.)

Written by Mark Mascolini on behalf of the International AIDS Society