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36 Higher serum vitamin D levels are associated with higher physical health-related quality of life in high-risk, older adults following non-st elevation acute coronary syndrome undergoing invasive care
  1. Benjamin Beska1,
  2. Dermot Neely2,
  3. Vijay Kunadian1
  1. 1Newcastle University
  2. 2Department of Biochemistry, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne


Introduction A large proportion of older patients with cardiovascular disease have low serum vitamin D levels. Such deficiency states have been linked with lower health-related quality of life (HRQoL). The Improve Cardiovascular Outcomes in High Risk PatieNts (ICON-1) study (NCT01933581) has previously demonstrated that serum vitamin D levels do not predict major adverse cardiovascular events (MACE) at 1 year in high-risk older adults being managed invasively for non-ST elevation acute coronary syndrome (NSTEACS). However, the relationship between serum vitamin D levels and HRQoL in older patients with NSTEACS is unclear. This further analysis of the ICON-1 cohort aims to investigate the relationship between serum vitamin D and HRQoL in high-risk, older adults managed invasively for NSTEACS.

Methods Patients aged ≥75 years presenting with NSTEACS (n=293) were recruited to the multi-centre prospective cohort ICON-1 study. Baseline serum total vitamin D was measured by electrochemiluminescent immunoassay prior to coronary angiography, split into two groups by the median for analysis. HRQoL was assessed within 24 hours post-procedure using the Short Form 36 Health Survey (SF-36) (License Number QM033917), values reported as norm-based scores. At one-year follow-up SF-36 scores were repeated. SF-36 consists of 4 physical subscales, summarised as Physical Component Summary. Statistical differences between groups were assessed with Kruskal-Wallis testing. Multi-variate linear regression was used to probe the impact of serum vitamin D on HRQoL adjusted for the a priori co-variates of age and sex.

Results Mean age was 80.4±4.8 years (61.8% male). Baseline median vitamin D was 29.0 [IQR 16.0–53.0] nmol/L. Patients were split by the median baseline vitamin D: low serum vitamin D (n=147, median 16.0 [IQR 12.0–23.0] nmol/L) and high serum vitamin D (n=146, median 53.0 [IQR 40.0–75.0] nmol/L). Both at baseline and at 1 year, those with a high serum vitamin D had significant higher scores in physical functioning (P<0.0001 at baseline and P=0.002 at 1 year, respectively) and physical component score (P=0.002 at baseline and P=0.038 at 1 year) compared to those with a low serum vitamin D (Table 1). At baseline, there was a significant association between serum vitamin D and a higher physical functioning (β=0.15, P=0.028) and physical component scores (β=0.16, P=0.009), after adjustment for age and sex (Table 2). This association was also apparent at 1-year follow-up, with a significant adjusted association between serum vitamin D and physical functioning (β=0.21, P=0.003).

Abstract 36 Table 1 Norm-based SF-36 domain differences between those with high serum vitamin D versus those with low serum vitamin D, both at baseline and at 1-year follow-up. SF-36, Short Form 36
Abstract 36 Table 2 Multiple linear regression analysis of serum vitamin D (high vs. low) and physical SF-36 scores. SF-36, Short Form 36; B, regression coefficient; SE(B), standard error of B; and β, standardised regression coefficient.

Conclusions There is an association, independent of age and sex, between serum vitamin D and physical health-related quality of life at both presentation and at 1-year follow-up after invasive management of NSTEACS in high-risk older adults. Although vitamin D deficiency has not been shown to predict MACE, it may play a plausible role in the significant morbidity experienced by older adults with cardiovascular disease.

Conflict of Interest None to declare

  • Acute coronary syndrome
  • Older adults
  • Vitamin D

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