Letter to the Editor
Vitamin D, vascular risk, and mortality in alcoholic patients
Vitamina D, riesgo vascular y mortalidad en pacientes alcohólicos
Geraldine Quintero-Platt
, Emilio González-Reimers, M. Candelaria Martín-González, Francisco Santolaria-Fernández
Corresponding author
Servicio de Medicina Interna, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain
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Candelaria Martín-González, Francisco Santolaria-Fernández" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Geraldine" "apellidos" => "Quintero-Platt" "email" => array:1 [ 0 => "geraldine588@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Emilio" "apellidos" => "González-Reimers" ] 2 => array:2 [ "nombre" => "M. Candelaria" "apellidos" => "Martín-González" ] 3 => array:2 [ "nombre" => "Francisco" "apellidos" => "Santolaria-Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vitamina D, riesgo vascular y mortalidad en pacientes alcohólicos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Aguilar del Rey<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> proposes a protocol for the treatment of vitamin D deficiency and stresses both its key role in bone metabolism and its effects on other body systems due to the ubiquity of its receptors. Furthermore, the author comments on the association between vitamin D deficiency and a higher incidence of neoplasia, greater fragility and increased vascular risk.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this context, we would like to comment on the as-yet preliminary results of a study conducted in 103 alcoholic male patients, aged 50.71<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.83 years, who drank 197<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>84 g/day of alcohol over 30<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 years, 68 of whom are smokers, with a median follow-up of 41 months (interquartile range [IR] 28-88 months), in which we tried to determine the relation between vitamin D and vascular mortality risk, with sarcopenia and with fragility. Vitamin D and homocysteine serum levels were determined in all of the patients, who also underwent routine laboratory tests including lipid profile determination, chest X-ray to determine the presence or absence of vascular calcifications, and densitometry to assess body composition (fat mass and lean mass). During follow-up 48 patients died; we assessed both overall mortality and mortality due to cancer, cardiovascular causes and liver failure.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The median vitamin D value was 26<span class="elsevierStyleHsp" style=""></span>ng/ml, with an IR of 19-40. Sixty-six patients had vitamin D levels below 30 ng/ml, a value that is generally used as the normal cut-off point<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a>. Vitamin D levels were generally lower in patients who died, though this tendency was not statistically significant (Z<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.43 and p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.1). Eight patients died due to cardiovascular causes but we found no relation between vitamin D and cardiovascular-cause mortality. In fact, we found a non-significant tendency towards higher mortality due to cancer (tendency towards higher mortality with vitamin D levels below 15 ng/ml, χ<span class="elsevierStyleSup">2</span> 3.9, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.083).</p><p id="par0020" class="elsevierStylePara elsevierViewall">We found no relation between vascular calcification and vitamin D levels. However, vitamin D was related to lean mass in the right arm (ρ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.23, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02), left arm (ρ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.27, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006), lower left limb (ρ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.20, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.043), lower right limb (ρ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.21, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.033), torso (ρ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.21, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.036) and total lean mass (ρ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.28, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005). We also found almost statistically significant relations in the 86 patients in whom dynamometry (ρ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.21, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.051), and BMI (ρ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.20, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.043) were studied. Therefore, vitamin D levels are significantly related to lean mass and almost statistically significantly related to muscle strength. In fact, vitamin D may have a marked effect on muscles. Vitamin D receptors were described in 2001 by Bischoff et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a>, who provided a convincing explanation for the proximal myopathy described in patients with osteomalacia<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and other conditions characteristic of vitamin D deficit<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a>. Moreover, this matches the results of a study conducted in rats fed with ethanol following the Lieber-DeCarli model, in which a relation between type <span class="elsevierStyleSmallCaps">ii</span> muscle fibre atrophy and low vitamin D levels<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> was observed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A reduction in lean mass is a prognostic factor for mortality<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a>, and sarcopenia is a determinant of fragility<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a>. The protein reserve is an essential element in the body's response capacity when facing an inflammatory reaction and, therefore, it is a determinant of survival<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a>. In our study, the lean mass of both the torso and right and left arms—all of which are related to vitamin D—was lower in the patients who died. In fact, in a Cox regression analysis, lean mass in the right arm was independently related to mortality, even when the first determining parameter of mortality was the liver function as assessed using Child's score.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Therefore, we conclude that, in alcoholic male patients, vitamin D is related to lean mass, which, in turn, is related to mortality. Vitamin D levels were slightly lower in the patients who died, though they were not statistically significant.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Quintero-Platt G, González-Reimers E, Martín-González MC, Santolaria-Fernández F. Vitamina D, riesgo vascular y mortalidad en pacientes alcohólicos. Reumatol Clin. Med Clin (Barc). 2015;144:138–139.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protocolo de tratamiento de la deficiencia de vitamina D" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2017 October | 6 | 2 | 8 |
| 2017 September | 12 | 3 | 15 |
| 2017 August | 10 | 6 | 16 |
| 2017 July | 19 | 2 | 21 |
| 2017 June | 12 | 1 | 13 |
| 2017 May | 9 | 2 | 11 |
| 2017 April | 13 | 6 | 19 |
| 2017 March | 8 | 8 | 16 |
| 2017 February | 8 | 0 | 8 |
| 2017 January | 3 | 0 | 3 |
