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Serum 25-hydroxyvitamin D levels and all-cause and cardiovascular disease mortality among US adults with hypertension: the NHANES linked mortality study

Zhao, Guixianga; Ford, Earl S.a; Li, Chaoyangb; Croft, Janet B.a

doi: 10.1097/HJH.0b013e32834e1f0a

Objectives: Research suggests that serum concentrations of 25-hydroxyvitamin D [25(OH)D] are inversely associated with hypertension incidence. This study examined whether concentrations of 25(OH)D are inversely associated with mortality risk among US adults with hypertension.

Methods: We analyzed data from the 2001–2004 National Health and Nutrition Examination Survey with mortality data obtained through 2006. Hazard ratios with 95% confidence intervals (CIs) for all-cause and cardiovascular disease (CVD) mortality were estimated using Cox proportional hazard models.

Results: Of 2609 participants with hypertension, 191 died (including 68 CVD deaths) during an average of 3.7-year follow-up. Compared with participants with 25(OH)D concentrations in the highest quartile (≥29 ng/ml), the hazard ratios for all-cause mortality were 1.93 (95% CI 1.06–3.49), 1.32 (95% CI 0.85–2.04), and 1.36 (95% CI 0.84–2.22), respectively (P for trend <0.05), and the hazard ratios for CVD mortality were 3.21 (95% CI 1.14–8.99), 2.42 (95% CI 0.85–6.90), and 2.33 (95% CI 0.88–6.12), respectively (P for trend <0.05), in the first (<17 ng/ml), second (17–<23 ng/ml) and third (23–<29 ng/ml) quartiles of 25(OH)D after adjustment for potential confounding variables. Additionally, concentrations of 25(OH)D as a continuous variable were linearly and inversely associated with the risk of mortality from all causes (P = 0.012) and from CVD (P = 0.010). These relationships were not affected much by adjustment for baseline blood pressure and use of antihypertension medications.

Conclusion: Concentrations of 25(OH)D were inversely associated with all-cause and CVD mortality among adults with hypertension in the US. Enhancing vitamin D intake may contribute to a lower risk for premature death.

aDivision of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion

bDivision of Behavioral Surveillance, Public Health Surveillance Program Office, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Correspondence to Guixiang Zhao, MD, PhD, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop K67, Atlanta, GA 30341, USA. Tel: +1 404 498 6018; fax: +1 404 498 0590; e-mail:

Abbreviations: 25(OH)D, serum 25-hydroxyvitamin D; CI, confidence interval; CVD, cardiovascular disease; GFR, glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; ICD, International Classification of Diseases; MEC, mobile examination center; MET, metabolic equivalent; NCHS, National Center for Health Statistics; NDI, National Death Index; NHANES, National Health and Nutrition Examination Survey

Received 20 June, 2011

Revised 1 September, 2011

Accepted 13 October, 2011

© 2012 Lippincott Williams & Wilkins, Inc.