维生素 D 与多发性硬化症的心血管后果。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-11-03 DOI:10.1016/j.msard.2024.106155

Madeleine France-Ratcliffe , Stephanie L. Harrison , Leona A. Verma , Azmil H. Abdul-Rahim , Linsay McCallum , Carolyn A. Young , Garry McDowell , Benjamin JR Buckley

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引用次数: 0

摘要

背景：维生素D（25（OH）D）缺乏与普通人群心血管疾病（CVD）风险增加有关，但其对多发性硬化症患者（pwMS）的影响仍未得到探讨。本研究旨在评估25（OH）D与多发性硬化症患者长期心血管疾病结果的关系以及维生素D补充剂的影响：这项观察性队列研究分析了来自 70 家医疗机构的匿名病历，这些病历对 PwMS 进行了为期 5 年（2019-2024 年）的跟踪调查。在人口统计学、合并症和心血管护理方面，25（OH）D水平缺乏或不足的pwMS与25（OH）D水平充足的pwMS进行了1:1倾向得分匹配。Cox 比例危险模型分析了全因死亡率、中风、急性心肌梗死、心力衰竭、心绞痛、心房颤动/扑动以及主要不良心血管事件 (MACE) 的复合指标。将服用胆钙化醇的25(OH)D水平缺乏或不足的倾向匹配的老年男性和25(OH)D水平充足（未服用补充剂）的老年男性进行比较：在 74 372 名儿童中，9% 的人 25(OH)D 水平不足，18% 的人不足，73% 的人充足。与25（OH）D水平充足者相比，25（OH）D水平缺乏或不足与MACE发生率增加有关（HR，1.32 [95 % CI：1.19, 1.46]；HR，1.29 [95 % CI：1.20, 1.40]）。与25（OH）D水平充足且未补充维生素D的人群相比，补充胆钙化醇并不能降低心血管疾病的发病率（HR，1.39 [95 % CI：1.21,1.60]；HR，1.31 [95 % CI：1.17,1.47]）：结论：乳腺癌患者25（OH）D水平缺乏或不足与MACE发生率增加有关，但维生素D补充剂可能无法缓解这一问题。

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Vitamin D and cardiovascular outcomes in multiple sclerosis

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Vitamin D and cardiovascular outcomes in multiple sclerosis

Background

Vitamin D (25(OH)D) deficiency is linked to increased cardiovascular disease (CVD) risk in the general population, but its implications for people with multiple sclerosis (pwMS) remain unexplored. This study aimed to evaluate the association of 25(OH)D with long-term CVD outcomes in pwMS and the impact of vitamin D supplementation.

Methods

This observational cohort study analysed anonymised medical records from 70 healthcare organisations following pwMS for 5-years (2019–2024). PwMS and deficient or inadequate 25(OH)D levels were 1:1 propensity-score matched with pwMS and adequate 25(OH)D levels, for demographics, comorbidities, and cardiovascular care. Cox proportional hazard models analysed the incidence of all-cause mortality, stroke, acute myocardial infarction, heart failure, angina, atrial fibrillation/flutter, and a composite measure of major adverse cardiovascular events (MACE). Propensity-matched pwMS who had deficient or inadequate 25(OH)D levels taking cholecalciferol were compared to pwMS and adequate 25(OH)D levels (not taking supplementation).

Results

Amongst 74,372 pwMS, 9 % had deficient 25(OH)D levels, 18 % inadequate, and 73 % adequate. Deficient, or inadequate 25(OH)D levels were associated with an increased rate of MACE (HR, 1.32 [95 % CI: 1.19, 1.46], HR, 1.29 [95 % CI: 1.20, 1.40], respectively) compared to those with adequate levels. Cholecalciferol supplementation in pwMS and deficient or inadequate 25(OH)D levels did not alleviate the higher CVD rate (HR, 1.39 [95 % CI: 1.21,1.60], HR, 1.31 [95 % CI: 1.17, 1.47], respectively) in comparison to those with adequate 25(OH)D levels taking no vitamin D supplementation.

Conclusions

Deficient or inadequate 25(OH)D levels in pwMS were associated with an increased rate of MACE, which may not be mitigated by vitamin D supplementation.

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.