on April 16, 2008
Published online before print April 16, 2008, doi: 10.1161/ATVBAHA.108.165886
Submitted on January 25, 2008
Accepted on March 26, 2008
Serum 25-Hydroxyvitamin D Levels and the Prevalence of Peripheral Arterial Disease. Results from NHANES 2001 to 2004
Michal L. Melamed *;
From the Departments of Medicine and Epidemiology & Population Health (M.L.M.), Albert Einstein College of Medicine, Bronx, New York; the Department of Medicine (P.M., J.U.), Mount Sinai School of Medicine, New York, New York; the Division of Cardiology (E.D.M.), Johns Hopkins University School of Medicine, Baltimore, Md; and the Department of Surgery (C.W., J.S.), and the Division of Cardiology (P.R.), Emory University School of Medicine, Atlanta, Ga.
* To whom correspondence should be addressed. E-mail: mmelamed{at}aecom.yu.edu.
Objective—The purpose of this study was to determine the association between 25-hydroxyvitamin D (25(OH)D) levels and the prevalence of peripheral arterial disease (PAD) in the general United States population.
Methods and Results—We analyzed data from 4839 participants of the National Health and Nutrition Examination Survey 2001 to 2004 to evaluate the relationship between 25(OH)D and PAD (defined as an ankle-brachial index <0.9). Across quartiles of 25(OH)D, from lowest to highest, the prevalence of PAD was 8.1%, 5.4%, 4.9%, and 3.7% (P trend <0.001). After multivariable adjustment for demographics, comorbidities, physical activity level, and laboratory measures, the prevalence ratio of PAD for the lowest, compared to the highest, 25(OH)D quartile (<17.8 and 
29.2 ng/mL, respectively) was 1.80 (95% confidence interval: 1.19, 2.74). For each 10 ng/mL lower 25(OH)D level, the multivariable-adjusted prevalence ratio of PAD was 1.35 (95% confidence interval: 1.15, 1.59).
Conclusions—Low serum 25(OH)D levels are associated with a higher prevalence of PAD. Several mechanisms have been invoked in the literature to support a potential antiatherosclerotic activity of vitamin D. Prospective cohort and mechanistic studies should be designed to confirm this association.
Key words: 25-hydroxyvitamin D • peripheral arterial disease • phosphate • PTH • cardiovascular disease