Vitamin D deficiency and electrocardiographic subclinical myocardial injury: Results from National Health and Nutrition Examination Survey-III

Clin Cardiol. 2018 Nov;41(11):1468-1473. doi: 10.1002/clc.23078. Epub 2018 Nov 20.


Background: Association of cardiovascular disease (CVD) with nontraditional risk factors such as vitamin D deficiency has been examined previously. An investigation of the association of vitamin D with subclinical myocardial injury (SC-MI) based on an electrocardiographic score is a simple, cost-effective and innovative way to explore this relationship.

Hypothesis: We hypothesize that low vitamin D levels will be associated with prevalent SC-MI independent of traditional CVD risk factors, lifestyle factors, and socioeconomic status.

Methods: This analysis included 6079 participants (58.3 ± 13.1 years; 54.1% women) without CVD from the third National Health and Nutrition Examination Survey. A multivariable logistic regression model was used to examine the association between vitamin D categories (<20, 20-29, and >30 ng/mL (reference) and cardiac injury score.

Results: There was an incremental increase in the prevalence of SC-MI across vitamin D categories with the highest prevalence in <20 ng/mL, followed by 20 to 29 ng/mL and then >30 ng/mL (trend P-value <0.0001). There was a statistically significant association between vitamin D deficiency (<20 ng/mL) and SC-MI (odds ratio [OR] (95% confidence interval [CI]): 1.27 (1.04-1.55), P = 0.04). This association was stronger in men than women (OR (95% CI): 1.74 (1.32-2.30) vs 0.94 (0.70-1.25) respectively; interaction P-value 0.002).

Conclusions: Vitamin D deficiency is associated with SC-MI, especially in men. These findings may further highlight the role of nontraditional risk factors in the development of CVD. The value of vitamin D supplementation in the prevention of myocardial ischemia and injury may warrant investigation.

Keywords: NHANES III; subclinical myocardial injury; vitamin D deficiency.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cross-Sectional Studies
  • Electrocardiography*
  • Female
  • Heart Diseases / diagnosis*
  • Heart Diseases / epidemiology*
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Predictive Value of Tests
  • Prevalence
  • Risk Factors
  • Sex Factors
  • Social Class
  • United States / epidemiology
  • Vitamin D / analogs & derivatives*
  • Vitamin D / blood
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / diagnosis
  • Vitamin D Deficiency / epidemiology*


  • Biomarkers
  • Vitamin D
  • 25-hydroxyvitamin D