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Major Electrocardiographic Abnormalities and 25‐Hydroxy Vitamin D Deficiency: Insights from National Health and Nutrition Examination Survey‐III
Abstract
Background: We explored the relationship between major electrocardiogram (ECG) abnormalities (mECG) and 25‐hydroxy (25‐OH) vitamin D deficiency (VDD) and the effect of mECG abnormalities on all‐cause and cardiovascular mortality in a healthy cohort with 25‐OH vitamin D insufficiency and deficiency. Hypothesis: Lower levels of serum 25‐OH vitamin D are associated with increased prevalence of mECG on resting ECG. Methods: We identified 5108 individuals from the National Health and Nutrition Examination Survey‐III. mECG abnormalities included: major Q‐QS wave abnormalities, ST depression/elevation, negative T waves, Wolff‐Parkinson‐White pattern, and ventricular conduction defect. Our cohort was divided into 3 groups based on 25‐OH vitamin D levels: Group 1 (referent): >40 ng/mL; group 2 (insufficient): ≥20.01 to ≤40 ng/mL; and group 3 (deficient): ≤20 ng/mL. Logistic regression and Cox proportional hazards regression models were built. Results: The prevalence of major ECG abnormalities across 25‐OH vitamin D sufficiency, insufficiency, and deficiency was 5.9%, 11%, and 13 %, respectively (P = 0.01). VDD was an independent predictor of mECG abnormalities after adjusting for traditional risk factors (continuous variable odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.97‐0.99, P = 0.007; categorical variable group 3 vs group 1 OR: 2.36, 95% CI: 1.1‐5.12, P = 0.03). Baseline major ECG abnormalities were predictive of long‐term all‐cause (hazard ratio [HR]:1.52, 95% CI: 1.23‐1.89), composite cardiovascular (HR: 1.7, 95% CI: 1.34‐2.15), cardiovascular (HR: 1.64, 95% CI: 1.27‐2.12), and ischemic heart disease mortality (HR: 1.98, 95% CI: 1.46‐2.69) in individuals with 25‐OH vitamin D levels ≤40 ng/mL. Conclusions: VDD is associated with increased prevalence of major ECG abnormalities. Well‐structured trials are needed to assess progression/resolution of mECG abnormalities with vitamin D supplementation in deficient individuals.
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“Individuals with 25-OH vitamin D levels below 40 ng/mL exhibited major ECG abnormalities that were independently and significantly associated with an increased risk of long-term all-cause combined cardiovascular (CV) events and ischaemic heart disease (37).”
From The decline of vitamin D in adolescent athletes: insights from a one-year follow-up and its association with electrocardiographic changes (2025) · cites this paper as [37]
In the citing paper
“A study conducted by Tuliani et al. (37), which included 5,108 participants from the Third National Health and Nutrition Examination Survey (NHANES-III), identified a correlation between vitamin D insufficiency and notable electrocardiographic (ECG) abnormalities (37).”
From The decline of vitamin D in adolescent athletes: insights from a one-year follow-up and its association with electrocardiographic changes (2025) · cites this paper as [37]
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Cited by
Ramadan, M. M., Jaber, A. A., Aladwani, A. J., Alayyaf, A. E., Sayed-Noor, A. S., Ghanem, H. B., El-Sherbiny, M., Ebrahim, H. A., Ahmed, M. M., & Elsherbini, D. M. A. (2025) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2025.1731919 · Cited by 1
Metadata
- Authors
- Tuliani, T. A., Shenoy, M., Deshmukh, A., Rathod, A., Pant, S., Badheka, A. O., Levine, D., & Afonso, L.
- Affiliations
- Department of Internal Medicine, Division of Cardiology Wayne State University/Detroit Medical Center Detroit Michigan
- Department of Cardiology University of Arkansas Little Rock Arkansas
- Department of Cardiology Cedars‐Sinai Medical Center Los Angeles California
- Venue
- Clinical Cardiology
- Publisher
- Wiley
- Published
- 2014-09-15
- Volume
- 37
- Issue
- 11
- Pages
- 660-666
- ISSN
- 0160-9289
- 1932-8737
- Cited by
- 10
- References
- 0
- Language
- en
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- The paper
- Tuliani, T. A., Shenoy, M., Deshmukh, A., Rathod, A., Pant, S., Badheka, A. O., Levine, D., & Afonso, L. (2014). Major Electrocardiographic Abnormalities and 25‐Hydroxy Vitamin D Deficiency: Insights from National Health and Nutrition Examination Survey‐III. Clinical Cardiology. https://doi.org/10.1002/clc.22329
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