Stabil koroner arter hastalığı olan hastalarda serum d vitamini ve çıplak metal stent restenozu arasındaki ilişki
Amaç Düşük D vitamini düzeylerinin artmış kardiyovasküler risk faktörleri ve yan etkiler ile ilişkili olduğu gösterilmiştir. Çalışmamızda serum D vitamini düzeyi ile çıplak metal stent restenozu arasındaki ilişki araştırıldı. Metod Çalışmaya stabil koroner arter hastalığı olan ve daha önce çıplak metal sten implante edilmiş (> 3 ay) olan toplam 181 hasta dahil edildi. Anjiyografik sonuçlara göre Grup 1 (≥% 50 stent darlığı) ve Grup 2 (<% 50 stent darlığı) olarak iki grup oluşturuldu. Serum D vitamini ölçümleri ters faz HPLC ile yapıldı. Bulgular Ortalama serum D vitamini düzeyleri Grup 1'de Grup 2'ye göre anlamlı derecede düşük bulundu (sırasıyla 17.7 ± 5.3 ng / ml ve 20.9 ± 6.7 ng / ml, p <0.001) ve stent uzunluğu Grup 1'de Grup 2'ye göre daha uzun bulundu (sırasıyla 18.7 ± 5.3 mm ve 17.1 ± 11.2 mm, p <0.001). Çok değişkenli lojistik regresyon analizinde, sadece düşük serum D vitamini düzeyi ve stent uzunluğu, çıplak metal stent restenozu için bağımsız risk faktörleriydi. Sonuç Düşük D vitamini düzeyi stent stentenozuna neden olan fibrozis ve inflamasyonla ilişkili olabilir. D vitamini takviyesinin stent restenozunu önleyip önleyemeyeceğini belirlemek için ileri çalışmalar yapılması önerilir.
The relationship between serum vitamin d and bare-metal in-stent restenosis in patients with stable coronary artery disease
Aim: It has been shown that low levels of vitamin D are associated with increased cardiovascular risk factors and adverse events. The relationship between serum vitamin D level and bare-metal stent in-stent restenosis was investigated in our study.Material and Methods: A total of 181 patients with stable coronary artery disease and previously implanted (>3 months) bare-metal stent were included in the study. Two groups were formed according to angiographic results as Group 1 (≥50% in-stent stenosis) and Group 2 (<50% in-stent stenosis). Serum vitamin D measurements were performed by reverse-phase HPLC. Results: The mean serum vitamin D levels were found to be significantly lower in Group 1 compared to Group 2 (17.7 ± 5.3 ng/ml and 20.9 ± 6.7 ng/ml, p<0.01, respectively) and length of stent was longer in Group 1 compared to Group 2 (18.7 ± 5.3 mm and 17.1 ± 11.2 mm, p<0.01, respectively). In multivariate logistic regression analysis, only low level of serum vitamin D and stent length were independent risk factors for bare-metal in-stent stenosis.Conclusion: Low level of vitamin D might be related to fibrosis and inflammation resulting in in-stent stenosis. Further studies are warranted to determine whether vitamin D supplementation could prevent progression of stent re-stenosis.
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- 1. Casteels K, Waer M, Bouillon R, Depovere J, Valckx D, Laureys J, Mathieu C. 1,25-Dihydroxyvitamin D3 restores sensitivity to cyclophosphamide-induced apoptosis in non-obese diabetic (NOD) mice and protects against diabetes. Clin Exp Immunol 1998; 112: 181-7
- 2. Martins D, Wolf M, Pan D et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2007; 167: 1159–65.
- 3. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med 2008; 168: 1174–80.
- 4. Kovesdy CP, Ahmadzadeh S, Anderson JE & Kalantar-Zadeh K. Association of activated vitamin D treatment and mortality in chronic kidney disease. Archives of Internal Medicine 2008; 168: 397–403.
- 5. Wang TJ, Pencina MJ, Booth SL et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117: 503–11.
- 6. Repo JM, Rantala IS, Honkanen TT et al. Paricalcitol aggravates perivascular fibrosis in rats with renal insufficiency and low calcitriol. Kidney International 2007; 72: 977–84.
- 7. Curcio A, Torella D, Indolfi C. Mechanisms of smooth muscle cell proliferation and endothelial regeneration after vascular injury and stenting: approach to therapy. Circ J 2011; 75: 1287-96.
- 8. Farb A, Weber DK, Kolodgie FD, Burke AP, Virmani R. Morphological predictors of restenosis after coronary stenting in humans. Circulation 2002; 105: 2974–80.
- 9. Uchida Y, Uchida Y, Matsuyama A, Koga A, Kanai M, Sakurai T. Formation of web- and membrane-like structures on the edges of bare-metal coronary stents. Circ J 2010; 74: 1830–6.
- 10. Fuke S, Maekawa K, Kawamoto K, Saito H, Sato T, Hioka T, Ohe T. Impaired endothelial vasomotor
function after sirolimus-eluting stent implantation. Circ J 2007; 71: 220–5.
- 11. Wakasugi M, Noguchi T, Inoue M, Kazama Y, Tawata M, Kanemaru Y, Onaya T. Vitamin D3 stimulates the production of prostacyclin by vascular smooth muscle cells. Prostaglandins 1991; 42: 127-36.
- 12. Artaza JN, Norris KC. Vitamin D reduces the expression of collagen and key profibrotic factors by inducing an antifibrotic phenotype in mesenchymal multipotent cells. J Endocrinol 2009; 200: 207–21.
- 13. Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-
controlled trial. Am J Clin Nutr 2006; 83: 754–9.
- 14. Wang L, Manson JE, Song Y, Sesso HD. Systematic review: vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 2010;152:315–323.
- 15. Wynn TA. Common and unique mechanisms regulate fibrosis in various fibroproliferative diseases. J Clin Invest 2007; 117: 524-9.
- 16. Al Mheid I, Patel R, Murrow J e al. Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans. J Am Coll Cardiol 2011; 58: 186-92.
- 17. Sugden JA, Davies JI, Witham MD, Morris AD, Struthers AD. Vitamin D improves endothelial function in patients with type 2 diabetes mellitus and low vitamin D levels. Diabet Med 2008; 25: 320-5.
- 18. Tarcin O, Yavuz DG, Ozben B et al. Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metab 2009; 94: 4023-30.
- 19. Motiwala SR, Wang TJ. Vitamin D and cardiovascular disease. Curr Opin Nephrol Hypertens 2011 ;20: 345-53.
- 20. Scragg RK, Camargo CA Jr, Simpson R. Relation of serum 25-hydroxyvitamin D to heart rate and cardiac work (from the National Health and Nutrition Examination Surveys). Am J Cardiol 2010; 105: 122–8.
- 21. Pittas AG, Sun Q, Manson JE, Dawson-Hughes B, Hu FB. Plasma 25-hydroxyvitamin D concentration and risk of incident type 2 diabetes in women. Diabetes Care 2010; 33: 2021–3.
- 22. Melamed ML, Muntner P, Michos ED, Uribarri J, Weber C, Sharma J, Raggi P. Serum 25-hydroxyvitamin D levels and the prevalence of peripheral arterial disease: results from NHANES 2001 to 2004. Arterioscler Thromb Vasc Biol 2008; 28: 1179-85.
- 23. Dobnig H, Pilz S, Scharnagl H et al. Independent association of low serum 25 hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med 2008; 168: 1340-9.
- 24. Schierbeck LL, Jensen TS, Bang U, Jensen G, Køber L, Jensen JE. Parathyroid hormone and vitamin D-markers for cardiovascular and all cause mortality in heart failure. Eur J Heart Fail 2011; 13: 626-32.
- 25. Akin F, Ayça B, Köse N et al. Serum Vitamin D Levels Are Independently Associated With Severity of Coronary Artery Disease. J Investig Med 2012; 60: 869-73.