Association of Vitamin D Deficiency with Peripheral Arterial Disease: A Meta-Analysis of Literature Studies

Abstract

Context Patients with vitamin D deficiency have increased cardiovascular (CV) morbidity and mortality. Contrasting data are available about the association between peripheral arterial disease (PAD) and vitamin D status. Objective To perform a meta-analysis of studies evaluating the association between vitamin D status and PAD. Data sources Studies were systematically searched in the PubMed, Web of Science, Scopus, and EMBASE databases. Results Ten studies with data on vitamin D levels in 2079 patients with PAD and 18,233 non-PAD control subjects and six studies on the prevalence of PAD in 23,171 subjects with vitamin D deficiency (<20 ng/mL), 48,311 subjects with vitamin D insufficiency (20 to 30 ng/mL), and 27,910 with normal vitamin D levels (>30 ng/mL) were included. Compared with control subjects, patients with PAD showed significantly lower vitamin D levels [mean difference: -2.24 ng/mL, 95% confidence interval (CI): -3.38 to -1.10, P < 0.001; I 2 = 86.5%, P < 0.001]. Moreover, a higher prevalence of PAD was found in subjects with vitamin D insufficiency [odds ratio (OR): 1.098, 95% CI: 1.010 to 1.195, P = 0.029; I 2: 0%, P = 0.600] and in subjects with vitamin D deficiency (OR: 1.484, 95% CI: 1.348 to 1.635, P < 0.001; I 2: 7.65%, P = 0.367) compared with control subjects with normal vitamin D levels. Sensitivity analyses and the analysis of data on the cumulative risk of PAD according to vitamin D levels derived from multivariate analysis consistently confirmed the results. Conclusions Patients with PAD have lower vitamin D levels than control subjects, and both vitamin D deficiency and vitamin D insufficiency are significantly associated with PAD. Reduced vitamin D levels might represent an independent risk factor for PAD and, in turn, for CV events.