Vitamin D Deficiency is A Risk Factor for Carotid Atherosclerosis

in Women with Rheumatoid Arthritis

Abstract
Background Although there is increasing evidence that low serum 25-hydroxy vitamin D (25-
OHD) is associated with a higher frequency of cardiovascular diseases (CVDs) in the general
population, little attention has been given to the relationship between vitamin D deficiency and
atherosclerosis in patients with rheumatoid arthritis (RA).

Objectives The present study aimed to investigate whether vitamin D deficiency is a potential
risk factor for carotid atherosclerosis in patients with (RA).

Methods With a cross-sectional design, we recruited 60 consecutive female RA patients without

previous CVDs between September 2013 and December 2013 at the outpatient rheumatology
clinic of a tertiary referral centre in South Korea. Carotid intima media thickness (CIMT) was
measured using high-resolution ultrasonography (Philips HD15, Bothwell, WA, USA) and
QLAB's IMT-quantification software plug-in (Philips Healthcare, DA Best, The Netherlands)
was used to enhance the consistency and reliability of CIMT measurement. Serum 25-OHD
levels were assessed by radioimmunoassay. Stepwise multivariable linear regression models
were used to evaluate the association between serum 25-OHD levels and CIMT.

Results Mean (SD) age and disease duration were 56.0 (11.2) and 5.9 (4.9) years, respectively.
Median 25-OHD levels (IQR) was 14.0 (11.0-20.7) ng/mL and 74% of patients had vitamin D
deficiency (<20ng/mL). Mean (SD) CIMT was 0.58 (0.08) mm and 24 (48%) RA patients had
abnormal CIMT (≥6 mm). Compared to RA patients with normal CIMT (<6mm), those with
abnormal CIMT (≥6 mm) were older and had longer disease duration, lower serum 25-OHD
levels and high density lipoprotein (HDL) and higher disease activity score (DAS) 28 and
Korean version of health assessment questionnaire (K-HAQ) score. In univariable analyses,
lower serum 25-OHD levels and HDL, older age, and higher DAS28 and K-HAQ scores were
associated with increased CIMT (Table 1), while disease duration, blood pressure, triglyceride,
low density lipoprotein and Homeostatic model assessment - insulin resistance showed no
association with CIMT. Serum 25-OHD levels remains statistically significant in multivariable
regression models after adjusting confounding factors (Table 1).
Conclusions Our data suggests that vitamin D deficiency is a risk factor for subclinical atherosclerosis in
female patients with RA. Larger prospective studies are needed to confirm our observation.