Kronik Koroner Sendrom Tanısı Alan Hastalarda D Vitamini Eksikliği ile CHA2DS2-VASc Skoru Arasındaki İlişki

Öz

Amaç: Kronik koroner sendrom (KKS) tanılı hasta grubunda D vitamini eksikliği ile CHA2DS2-VASc skoru arasındaki ilişkiyi tespit etmeyi amaçladık. Gereç ve Yöntem: Çalışmaya KKS tanısı konmuş ve koroner anjiografi uygulanmış ve kritik koroner arter darlığı saptanan 147 hasta retrospektif olarak alındı. Hastaların CHA2DS2-VASc skorları hesaplandı. Laboratuvar bulguları, D vitamin düzeyleri ve ekokardiyografi parametreleri kaydedildi. CHA2DS2-VASc skoruna göre; <3 ise düşük-orta skor grubu, skor ≥3 ise yüksek skor grubu olarak sınıflandırıldı. Bulgular: Ortalama yaş: 62.7±10.5 ve hastaların 80 (%54.4)’ i kadın idi. Yüksek skor grubundaki hastalar daha yaşlı idi (63.6±10.7, p<0.001). Vücut kitle indeksi (VKİ) ve diyabetes mellitus (DM) sıklığı yüksek skor grubunda daha fazlayken (p=0.003 ve p<0.001, sırasıyla), D vitamin düzeyi ve Ejeksiyon fraksiyonu ise anlamlı olarak daha düşüktü (p<0.001 ve p=0.02, sırasıyla). Çok değişkenli lojistik regresyon analizi yapıldığında, VKİ (Olasılık Oranı=1.383; %95 Güvenlik Aralığı=1.155-1.657), ve D vitamin düzeyinin (Olasılık Oranı=0.852; %95 Güvenlik Aralığı 0.776-0.935), yüksek CHA2DS2-VASc skorunu öngörme de bağımsız belirteçler olduğu izlendi. ROC analizi yapıldığında D vitamin düzeyi 23.6 ng/ml ‘‘kesim değeri’’ olarak alındığında %61 duyarlılık ve %84 özgüllük ile yüksek CHA2DS2-VASc skorunu belirlediği bulundu. Sonuç: Kronik koroner sendrom tansıyla koroner anjiyografi uygulanan hastalarda düşük D vitamini düzeyi ile yüksek CHA2DS2-VASc skoru arasında bağımsız bir ilişki olduğu tespit edildi.

Anahtar Kelimeler

• Kronik Koroner Sendrom
• D Vitamin
• CHA2DS2-VASc Skoru

The Relationship Between Vitamin D Deficiency And CHA₂DS₂-VASc Score in Chronic Coronary Syndrome

Öz

Objective: To assess the relationship between Vitamin D level and CHA2DS2-VASc score in patients with chronic coronary syndrome (CCS). Methods:A total of 147 participants with CCS who underwent coronary angiography and had critical coronary artery stenosis were retrospectively enrolled in the study. Patients’ CHA2DS2-VASc scores were measured. Laboratory parameters including vitamin D and echocardiographic findings were recorded. Participants were divided into two groups according to CHA2DS2-VASc score, CHA2DS2-VASc score <3 as low-moderate group and CHA2DS2-VASc score ≥3 as high group. Results: Mean age was 62.7±10.5 and 80 (54.4%) were female. Age was older in the group with high CHA2DS2-VASc score (63.6±10.7 vs 56.6±6.3, p<0.001). Body mass index (BMI) and diabetes mellitus (DM) frequency were higher in the high score group (p=0.003 and p<0.001, respectively), whilst ejection fraction and vitamin D level were lower (p=0.02 and p<0.001, respectively). In multivariate logistic regression analysis with forward selection, BMI (OR: 1.383, 95% CI: 1.155-1.657, p<0.001) and Vitamin D level (OR: 0.852, 95% CI: 0.776-0.935, p=0.001) were independently associated with high CHA2DS2-VASc score. A cut-off value of 23.6 ng/ml for vitamin D level predicted high CHA2DS2-VASc score, with 61% sensitivity and 84% specificity [AUC:0.755 (0.678-0.822), %95 CI, p<0.001] in receiver operating characteristic (ROC) curve analysis. Conclusion: In patients with CCS undergoing coronary angiography, it was determined an independent relationship between low vitamin D levels and high CHA2DS2-VASc score.

Anahtar Kelimeler

• Chronic Coronary Syndrome
• Vitamin D
• CHA2DS2-VASc Score

Kaynakça

1. January CT, Wann LS, Alpert JS Calkins H, Cigarroe JE, Cleveland JC, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol, 2014; 64: e1-e76. https://doi.org/10.1016/j.jacc.2014.03.022.
2. Biancari F, Asim Mahar MA, Kangasniemi OP. CHADS(2) and CHA(2)DS(2)-VASc scores for prediction of immediate and late stroke after coronary artery bypass graft surgery. J Stroke Cerebrovasc Dis, 2013; 22: 1304-1311. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.11.004.
3. Welles CC, Whooley MA, Na B, Ganz P, Schiller NB, Turakhia MP. The CHADS2 score predicts ischemic stroke in the absence of atrial fibrillation among subjects with coronary heart disease: data from the Heart and Soul Study. Am Heart J, 2011; 162: 555-561. https://doi.org/10.1016/j.ahj.2011.05.023.
4. Cerit L, Kemal H, Gulsen K, Ozcem B, Cerit Z, Duygu H. Relationship between vitamin D and the development of atrial fibrillation after on-pump coronary artery bypass graft surgery. Cardiovasc J Afr. 2017;28(2):104-7 https://doi.org/10.5830/CVJA-2016-064.
5. Sadiya A, Ahmed SM, Skaria S, Abusnana S. Vitamin D status and its relationship with metabolic markers in persons with obesity and type 2 diabetes in the UAE: a cross-sectional study. J Diabetes Res 2014;2014:869307. https://doi.org/10.1155/2014/869307.
6. Ginde AA, Scragg R, Schwartz RS, Camargo CA Jr. Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all-cause mortality in older U.S. adults. J Am Geriatr Soc. 2009;57:1595-603. https://doi.org/10.1111/j.1532-5415.2009.02359.x.
7. Kunadian V, Ford GA, Bawamia B, Qiu W, Manson JE. Vitamin D deficiency and coronary artery disease: a review of the evidence. Am Heart J 2014;167:283-91. https://doi.org/10.1016/j.ahj.2013.11.012.
8. Demir M, Uyan U, Melek M. The effects of vitamin D deficiency on atrial fibrillation. Clin Appl Thromb Hemost. 2014;20:98-103. https://doi.org/10.1177/1076029612453762.

9. Wang C. Role of vitamin D in cardiometabolic diseases. J Diabetes Res. 2013;2013:243934. https://doi.org/10.1155/2013/243934.
10. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41: 407- 477. https://doi.org/10.1093/eurheartj/ehz425.
11. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function a study in normals and dilated cardiomyopathy. J Cardiol 1995;26:357-66.
12. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atriyal fibrillation using a novel risk factor-based approach: the euro heart survey on atriyal fibrillation. Chest. 2010;137:263-272. https://doi.org/10.1378/chest.09-1584.
13. Lloyd-Jones D, Adams R, Carnethon M, Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics--2009 update: A report from the American Heart Association statistics committee and stroke statistics subcommittee. Circulation. 2009; 119:e21-181. https://doi.org/10.1161/CIRCULATIONAHA.108.191261.
14. Kannel WB, McGee DL. Diabetes and cardiovascular disease - Framingham Study. Jama. 1979; 241:2035-2038. https://doi.org/10.1001/jama.241.19.2035.
15. Karthikeyan G, Eikelboom JW. The CHADS2 score for stroke risk stratification in atrial fibrillation-friend or foe? Thromb Haemost. 2010;104:45-8. https://doi.org/10.1160/TH09-11-0757.
16. Zhou X, Cao K, Kou S, Qu S, Li H, Yu Y, et al. Usefulness of CHADS2 score for prognostic stratification of patients with coronary artery disease: a systematic review and meta-analysis of cohort studies. Int J Cardiol 2017;228:906-911. https://doi.org/10.1016/j.ijcard.2016.11.114.
17. Kurtul A, Yarlioglues M, Duran M. Predictive value of CHA2DS2-VASC score for contrast-induced nephropathy after percutaneous coronary intervention for acute coronary syndrome. Am J Cardiol. 2017;119(6):819-25. DOI: https://doi.org/10.1016/j.amjcard.2016.11.033.
18. Ünal S, Açar B, Yayla Ç, Balci MM, Ertem A, Kara M et al. Importance and usage of the CHA2DS2-VASc score in predicting acute stent thrombosis. Coron Artery Dis. 2016;27(6):478-82. https://doi.org/10.1097/MCA.0000000000000388.
19. Ipek G, Onuk T, Karatas MB, Gungor B, Osken A, Keskin M, et al. CHA2DS2-VASc score is a predictor of no-reflow in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous intervention. Angiology. 2016;67(9):840-5. https://doi.org/10.1177/0003319715622844.
20. Aksoy F, Bağcı A. Evaluation of CHA2DS2-VASc and ATRIA Scores in Patients With Acute Coronary Syndrome. Sdü Sağlık Bilimleri Dergisi / Cilt 10 Sayı 4 / 2019. https://doi.org/10.22312/sdusbed.551930
21. D’Ascenzo F, Biondi-Zoccai G, Moretti C, Bollati M, Omede P, Sciuto F, et al., TIMI, GRACE and alternative risk scores in acute coronary syndromes: a meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients, Control. Clin. Trials 33 (3) (2012) 507-514. https://doi.org/10.1016/j.cct.2012.01.001.
22. Verdoia M, Nardin M, Rolla R, Negro F, Gioscia R, Afifeh AMS, et al. Prognostic impact of Vitamin D deficiency in patients with coronary artery disease undergoing percutaneous coronary intervention Eur J Intern Med. 2020 Aug 20;S0953-6205(20)30332-0. https://doi.org/10.1016/j.ejim.2020.08.016.
23. Kendrick J, Targher G, Smits G, Chonchol M. 25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the third national health and nutrition examination survey. Atherosclerosis 2009;205:255-60. https://doi.org/10.1016/j.atherosclerosis.2008.10.033.
24. Seker T, Gur M, Yuksel Kalkan G, Kuloglu O, Yildiz Koyunsever N, Yildiray Sahin D, et al. Serum 25-hydroxyvitamin D level and extent and complexity of coronary artery disease. J Clin Lab Anal. 2014, 28: 52–58. pmid:24375475. https://doi: 10.1002/jcla.21643.
25. Brondum-Jacobsen P, Nordestgaard BG, Schnohr P, Benn M. 25-hydroxyvitamin D and symptomatic ischemic stroke: An original study and meta-analysis. Ann. Neurol. 2013, 73, 38-47. https://doi.org/10.1002/ana.23738.
26. Liu X, Wang W, Tan Z, Zhu X, Liu M, Wan R, et al. The relationship between vitamin D and risk of atrial fibrillation: a dose-response analysis of observational studies. Nutr J. 2019;18:73. https://doi.org/10.1186/s12937-019-0485-8.
27. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2014;1:CD007470. https://doi.org/10.1002/14651858.CD007470.pub3.
28. LeBoff MS, Murata EM, Cook NR, Cawthon P, Chou SH, Kotler G, et al. VITamin D and OmegA-3 TriaL (VITAL): Effects of Vitamin D Supplements on Risk of Falls in the US Population. J. Clin. Endocrinol. Metab. 2020, 105. https://doi: 10.1210/clinem/dgaa311.
29. Albert CM, Cook NR, Pester J, MoortHy MV, Ridge C, Danik JS, et al. Effect of marine omega-3 fatty acid and vitamin D supplementation on incident atrial fibrillation: a randomized clinical trial. JAMA. 2021;325(11):1061–1073. https://doi: 10.1001/jama.2021.1489.
30. Aurigemma GP, de Simone G, Fitzgibbons TP. Cardiac remodeling in obesity. Circ Cardiovasc Imaging 2013;6:142-152. https://doi.org/10.1161/CIRCIMAGING.111.964627.
31. Dublin S, French B, Glazer NL, Wiggins KL, Lumley T, Psaty BM, et al. Risk of new-onset atrial fibrillation in relation to body mass index. Arch Intern Med 2006;166:2322-2328. https://doi.org/10.1001/archinte.166.21.2322.
32. Wan H, Wu S, Wang J, Yang Y, Zhu J, Shao X, et al. Body mass index and the risk of all-cause mortality among patients with nonvalvular atrial fibrillation: a multicenter prospective observational study in China. Eur J Clin Nutr. 2017;71(4):494-9. https://doi.org/10.1038/ejcn.2016.183.
33. Lajous M, Banack HR, Kaufman JS, Hernan MA. Should patients with chronic disease be told to gain weight? The obesity paradox and selection bias. Am J Med 2015;128(4):334-6. https://doi.org/10.1016/j.amjmed.2014.10.043.
34. Aksoy F, Guler S, Kahraman F, Oskay T, Varol E. The Relation Between Echocardiographic Epicardial Fat Thickness and CHA2DS2-VASc Score in Patients with Sinus Rhythm. Braz J Cardiovasc Surg. Jan-Feb 2019;34(1):41-47. https://doi: 10.21470/1678-9741-2018-0230.