(05-06-12) A Reverse J-Shaped Association of Ali-Cause Mortality with Serum 25-Hydroxyvitamin D in Generai Practice, the CopD Study

D. Durup, H. L. Jerqensen, J. Christensen, P. Schwarz, A. M. Heegaard, and B. Lind
Department of Drug Design and Pharmacology (D.D., A.M.H.), Faculty of Health and Medicai Sciences, University of Copenhagen, 2100 Copenhagen, Denmark; Department of Clinical Biochemistry (HLJ), Bispebjerg Hospital, 2400 Copenhagen, Denmark; Department of Statistics and Epidemiology (JC), the Danish Cancer Society, 2100 Copenhagen Denmark; Research Center of Aging and Osteoporosis (P.S.), Department of Medicine, Glostrup University Hospital and Faculty of Health and Medicai Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; and Copenhagen Generai Practitioners Laboratory (BL), 1112 Copenhagen, Denmark
Context: Optimal levels of vitamin D have been a topic of heavy debate, and the correlation between 25-hydroxyvitamin D [25(OH)Djlevels and mortality stili remains to be established.
Objective: The ai m of the study was to determi ne the association between ali-cause mortai ity and serum levels of 25(OH)D, calcium, and PTH.
Design and Setting: We conducted a retrospective, observational cohort study, the CopD Study, in a single laboratory center in Copenhagen, Denmark.
Participants: Serum 25(OH)D was analyzed from 247,574 subjects from the Copenhagen generai practice sector. In addition, serum levels of calcium, albumin-adjusted calcium, PTH, and creatinine were measured in 111,536; 20,512; 34,996; and 189,496 of the subjects, respectively.
Main Outcome Measures: Multivariate Cox regression analysis was used to compute hazard ratios for ali-cause mortality.
Results: During follow-up (median, 3.07 yr), 15,198 (6.1 %) subjects died. A reverse J-shaped asso?ciation between serum level of 25(OH)D and mortality was observed. A serum 25(OH)D level of 50-60 nmol/liter was associated with the lowest mortality risk. Compared to 50 nmol/liter, the hazard ratios (95% confidence intervals) of ali-cause mortality at very low (10 nmol/liter) and high (140 nmol/liter) serum levels of 25(OH)D were 2.13 (2.02-2.24) and 1.42 (1.31-1.53), respectively. Similarly, both high and low levels of albumin-adjusted serum calcium and serum PTH were asso?ciated with an increased mortality, and secondary hyperparathyroidism was associated with higher mortality (P < 0.0001).
Conclusion: In this study from the generai practice sector, a reverse J-shaped relation between the serum level of 25(OH)D and ali-cause mortality was observed, indicating not only a lower limit but also an upper limit. The lowest mortality risk was at 50-60 nmol/liter. The study did not allow inference of causality, and further studies are needed to elucidate a possible causai relationship between 25(OH)D levels, especially higher levels, and mortality. (J C/in Endocrinol Metab 97: 0000-0000,2012)
ISSN Print 0021-972X ISSN Online 1945-7197 Printed in USA.


Source: J Clin Endocrin Metab. First published ahead of print May 9, 2012 as doi:1 0.121 0/jc.2012-1176
ORIGINAL ARTICLE
Endocrine Care

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