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
Ройтберг Г.Е. Роль адипокинов в прогрессировании метаболических нарушений у пациентов без ожирения с инсулинорезистентностью / Г.Е. Ройтберг, Ж.В. Дорош, О.В.
Курушкина // Профилактическая медицина. – 2010. – №5. – С. 23–26.
Vimaleswaran K.S. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts / K.S. Vimaleswaran, D.J. Berry, C. Lu et al. // PLoS Med. – 2013. – Vol. 10, №2. – P. 1–13.
Golay A. Link between obesity and type 2 diabetes / A. Golay, J. Ybarra // Clin. Endocrinol. Metab. – 2005. – Vol. 19, №4. – P. 649–663.
Коваленко А.Н. Развитие синдрома инсулинорезистентности и его осложнений у участников ликвидации последствий аварии на ЧАЭС / А.Н. Коваленко // Журнал НАМН України. – 2012. – Т. 18, №1. — С. 68–73.
Dloomgarden Z.T. World congress on insulin resistance, diabetes, and cardiovascular disease: part 4. / Z.T. Dloomgarden // Diabetes Care. – 2011. – Vol. 34, №10. – P. 152–157.
Schindler T.H. Improvement in coronary vascular dysfunction produced with euglycaemic control in patients with type 2 diabetes / T.H. Schindler, A.D. Facta, J.O. Prior et al. // Heart. – 2007. – Vol. 93, №3. – P. 345–349.
Скибчик В.А. Інсулінорезистентність: клінічне значення, методи визначення, підходи до лікування / В.А. Скибчик // Український медичний часопис. – 2006. – №6 (56). – С. 61 68.
Karnchanasorn R. Plasma 25-hydroxyvitamin D levels are favorably associated with β-cell function / R. Karnchanasorn, H.Y. Ou, K.C. Chiu // Pancreas. – 2012. – Vol. 41, №6. – P. 863–868.
Takiishi T. Vitamin D and diabetes / T. Takiishi, C. Gysemans, R. Bouillon et al. // Endocrinol. Metab. Clin. N. Am. – 2010. – Vol. 39. – P.419–446.
Cade C. Rapid normalization/stimulation by 1,25 dihydroxyvitamin D3 of insulin secretion and glucose tolerance in the vitamin D-defi cent rat / C. Cade, A.W. Norman // Endocrinology. – 1987. – Vol. 120. – P. 1490–1497.
Mitri J. Effects of vitamin D and calcium supplementation od pancreatic β-cell function, insulin sensitivity, and glycemia in adults at high risk of diabetes: The Calcium and Vitamin D for Diabetes Mellitus (CaDDM) randomized controlled trial / J. Mitri, B. Dawson-Hughes, F.B. Hu et al. // Am. J. Clin. Nutr. – 2011. – Vol. 94. – P. 486–494.
Pittas A.G. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults / A.G. Pittas, S.S. Harris, P.C. Stark et al. // Diabetes Care. – 2007. – Vol. 30. – P. 980–986.
Holick M.F. Vitamin D and health: evolution, biologic functions, and recommended dietary intakes for vitamin D / M.F. Holick // Clinic Rev. Bone Miner. Metab. – 2009. – Vol. 7 – P. 2–19.
Wedin W.K. Prediction of insulin resistance with anthropometric measures: lessons from a large adolescent population / W.K. Wedin, L. Diaz-Gimenez, A.J. Convit // Diabetes Metab. Syndr. Obes. – 2012. – Vol. 5. – P. 219–225.
Matthews D.R. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in man / D.R. Matthews, J.P. Hosker, A.S. Rudenski et al. // Diabetologia. – 1985. – Vol. 28. – P. 412–419.
Katz A. Quantitative insulin sensitivity check index: A simple, accurate method for assessing insulin sensitivity in humans / A. Katz, S.S. Nambi, K. Mather et al. // J. Clin. Endocrinol. Metab. – 2000. – Vol. 85 – P. 2402–2410.
Liu E. Plasma 25-hydroxyvitamin d is associated with markers of the insulin resistant phenotype in nondiabetic adults / E. Liu, J.B. Meigs, A.G. Pittas et al. // J. Nutr. – 2009. – Vol. 139, №2. – Р. 329–334.
Pinelli N.R. Serum 25-hydroxy vitamin d and insulin resistance, metabolic syndrome, and glucose intolerance among Arab Americans / N.R. Pinelli, L.A. Jaber, M.B. Brown et al. // Diabetes Care. – 2010. – Vol. 33. – P. 1373–1375.
Alemzadeh R. Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season / R. Alemzadeh, J. Kichler, G. Babar // Metabolism. – 2008. – Vol. 57. – P. 183–191.
Yin X. Serum 25(OH)D is inversely associated with metabolic syndrome risk profi le among urban middle-aged Chinese population / X. Yin, Q. Sun, X. Zhang et al. // Nutr. J.
– 2012. – Vol. 11. – P. 68–74.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
