Relationship of hypovitaminosis d and insulin resistance in patients with coronary heart disease and metabolic syndrome
DOI:
https://doi.org/10.14739/2310-1210.2013.4.16911Keywords:
vitamin D, calcitriol, insulin resistance, НОМА, coronary heart disease, CHD, metabolic syndromeAbstract
BACKGROUND: Insulin resistance (IR) - is one of the predictors of cardiovascular disease and progression of atherosclerosis, regardless of major classical risk factors. IR has become a global epidemic. Experimental data indicate that low concentration of vitamin D associated with IR, diabetes mellitus type 2, by reducing the sensitivity of peripheral tissues to insulin and dysfunction of β-pancreatic cells. Randomized studies showed that vitamin D supplements have a preventive role in the development of type 2 diabetes mellitus (DM). The present study aims to examine the association between serum vitamin D concentrations and indicators of carbohydrate metabolism, indexes of insulin resistance and insulin sensitivity in the patients with coronary artery disease.
METHODS: This study included 135 patients with CHD stable angina pectoris class II – III. The mean age was 64,7±0,97 years, 40% were women (n = 54). Patients were divided into two groups: I – with isolated CHD (70 patients) and II - CHD combined with MS (65 patients). MS was diagnosed according to the criteria of the International Diabetes Federation (IDF, 2005). The study did not include patients who received vitamin D2, D3 and multivitamins containing these vitamins for last 6 months, patients with malabsorption fat syndrome, acute and chronic liver disease, chronic renal failure, nephrotic syndrome, urolithiasis, and primary hyperparathyroidism. Also excluded from the study were patients with DM type 1 and type 2 taking glucose-lowering drugs.Serum 25(OH)D and insulin were measured by enzyme immunoassay (25-OH Vitamin D Immunodiagnostics Systems Limited (UK); DRG (USA)).
RESULT: Vitamin D deficiency or insufficiency was present in 91,9 % of the tested patients. Among subnormal values prevailed insufficiency in 51,9 % (70 pers.), deficit diagnosed in 40.0% of patients (54 pers.). Established that patients with CHD associated with MS have a significantly more pronounced hypovitaminosis D compared to patients with isolated CHD, the average concentration of 25(OH)D was 43,8±1,82 vs 60,1±2,17 nmol/l. In this study, we observed significant correlation of serum 25(OH)D with concentration of glucose, fasting insulin, insulin resistance indexes HOMA-IR, QUCKI and HOMA% S (p<0,001). Patients with CHD and MS had more close correlation between vitamin D and components of carbohydrate metabolism. In the present study shown that first quartile patients with the most pronounced hypovitaminosis D have higher levels of blood glucose, fasting insulin, indexes IR (HOMA-IR, QUCKI) and the lowest sensitivity of peripheral tissues to insulin (HOMA% S) compared with patients who had a level of 25 (OH ) D above 54.5 nmol/l.CONCLUSION: Vitamin D deficiency is common disorder in patients with CHD with high prevalence in patients with MS. Low vitamin D concentration was associated with insulin resistance. Discovered deficiency and insufficiency of vitamin D may be an additional pathogenic factor in the etiology and progression of CHD, which requires further investigation. Further studies are warranted the assotiation of hypovitaminosis D with the MS components, markers of subclinical inflammation and effectiveness of vitamin D supplementation.References
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