Association of lower vitamin D levels with inflammation and leukocytes parameters in patients with and without diabetes mellitus undergoing coronary angiography.

Verdoia, Monica; Nardin, Matteo; Rolla, Roberta; Negro, Federica; Gioscia, Rocco; Saghir Afifeh Arraa, Maddalena; Viglione, Filippo; Suryapranata, Harry; Marcolongo, Marco; De Luca, Giuseppe

BACKGROUND Diabetes mellitus has been associated with a chronic low-grade inflammation and a higher risk of cardiovascular and infectious disease, that could be prevented by the effects of vitamin D. We aimed at evaluating the impact of vitamin D levels on the biomarkers of acute-phase response, inflammation and glucose metabolism in a large cohort of diabetic patients with cardiovascular disease. METHODS Consecutive patients undergoing coronary angiography were included. Diabetes mellitus was defined as previous diagnosis, specific treatment administration (oral drug or insulin), fasting glycaemia > 6.99 mmol/l or HbA1c > 48 mmol/l. Glucose parameters, white blood cells, Neutrophyl-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), C-reactive protein (CRP) and vitamin D were measured at admission. Vitamin D levels were measured by chemiluminescence immunoassay kit LIAISON® Vitamin D assay (Diasorin Inc). RESULTS We included diabetic 1472 patients and 2499 non diabetic patients, that were divided according to vitamin D tertiles. Among diabetic patients, lower levels of vitamin D were associated with female gender, (p=0.02), obesity (p=0.004), active smoking and acute presentation (p<0.001) and with a more atherogenic metabolic profile. The levels of white blood cells, leukocytes subfamilies, and inflammatory parameters significantly correlated with vitamin D levels in both patients with and without diabetes (diabetic: p=0.012 for WBC, p=0.004 for NLR and p<0.001 for MLR and C-reactive protein, non-diabetic: p<0.001 for WBC; NLR, MLR and C reactive protein, respectively). Among diabetic patients, results were confirmed at multivariate analysis with no significant interaction according to glycemic control. CONCLUSION The present study demonstrates that, among patients with cardiovascular disease, vitamin D deficiency is associated with metabolic dysregulation and with an elevation of cellular and humoral inflammatory parameters, especially among diabetics, although not being dependent from glycaemic control.