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

CONTEXT: Vitamin D deficiency patients have an 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 2,079 PAD patients and 18,233 non-PAD controls and 6 studies on the prevalence of PAD in 23,171 subjects with Vitamin D deficiency (<20 ng/ml), 48,311 subjects with Vitamin D insufficiency (20-30 ng/ml) and 27,910 with normal Vitamin D levels (>30 ng/ml) were included. Compared to controls, PAD patients showed significantly lower Vitamin D levels (MD: -2.24 ng/ml; 95%CI: -3.38, -1.10; p<0.001, I2=86.5%; p<0.001). Moreover, a higher prevalence of PAD was found both in subjects with Vitamin D insufficiency (OR: 1.098, 95%CI: 1.010-1.195, p=0.029, I2: 0%, p=0,600) and in subjects with Vitamin D deficiency (OR: 1.484, 95%CI: 1.348-1.635, p<0.001, I2: 7.65%, p=0,367) compared with controls 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 results. CONCLUSIONS: PAD patients have lower vitamin D levels than controls 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.