Vitamin D Eksikliği Olan Menopoz Öncesi Kadınlarda Subklinik Ateroskleroz Belirteçlerinin Incelenmesi ve Vitamin D Replasmanının Bu Belirteçler Üzerindeki Etkisinin Araştırılması

Abstract

Recent studies have demonstrated that a relationship might exist between vitamin D deficiency and cardiovascular diseases, especially atherosclerosis. Vitamin D deficiency is prevalent among young women who are inhabitants of a region including Turkey and its role on development of atherosclerosis in this population has not been elucidated yet. The aim of this study is to evaluate the markers of subclinical atherosclerosis and the impact of vitamin D replacement in a cohort of vitamin D deficient premenopausal women. 31 patients and 27 control subjects were included in the study. Baseline carotid intima media thickness (cIMT), endothelial functions determined by flow-mediated dilatation (FMD), endothelial progenitor cell count and serum IL-10, IL-13, IL-17 and IFNγ levels of the study population were measured. In patients who were given vitamin D replacement therapy, measurements were repeated at the sixth month. Baseline cIMT measurements were similar in the patient and control groups (0.45± 0.02 vs 0.44± 0.02 mm, p=0.275). However, baseline FMD were found to be lower in the patient group (9.9± 1.3 vs. 13.8± 1.7 %, p<0.001). In the patient group endothelial progenitor cell count and IL-10 levels were also found to be lower and IL-17 levels were found to be higher when compared with the control group. Following 6 months-lasting vitamin D replacement therapy, no significant difference in cIMT (0.45± 0.02 vs. 0.44± 0.02, p=0.157); but a significant increase in FMD (9.9± 1.3 vs. 11.4± 1.4 %, p<0.001) was observed. After replacement therapy, a significant increase in IL-10, IL-13 levels and endothelial progenitor cell count and a significant decrease in IL-17 levels were observed. Change in FMD was positively correlated with changes in 25(OH)D, IL-10, IL-13 levels and endothelial progenitor cell count; where it was negatively correlated with changes in IL-17 levels. As a result, this study shows that vitamin D deficiency leads to a decrease in anti-inflammatory cytokine levels and endothelial progenitor cell count with increase in pro-inflammatory cytokine levels along with impairment in endothelial functions in otherwise healthy, premenopausal women. It is demonstrated that 6-month lasting vitamin D replacement therapy has positive impact on these parameters. These data suggest that vitamin D replacement in vitamin D deficient premenopausal women may provide a benefit for primary prevention of cardiovascular diseases.