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Resumen Antecedentes y objetivos El deficit de 25(OH)D se ha relacionado con un riesgo cardiovascular aumentado, aunque los estudios de intervencion son contradictorios. El objetivo principal fue evaluar el efecto del tratamiento con calcifediol (25(OH)D3) sobre el sistema cardiovascular en pacientes con sindrome coronario agudo sin elevacion de segmento ST. Pacientes y metodo Estudio prospectivo que incluyo a 41 pacientes (70,6 ±6,3 anos) ≥ 60 anos con sindrome coronario agudo sin elevacion de segmento ST y enfermedad coronaria revascularizada percutaneamente. Se aleatorizaron a recibir calcifediol + tratamiento habitual o tratamiento habitual exclusivo, con evaluacion de major adverse cardiovascular events (MACE, «episodios cardiovasculares mayores adversos») a los 3 meses. Se estudio la 25(OH)D en relacion con otras variables analiticas y con la extension de la enfermedad coronaria. Resultados Niveles basales de 25(OH)D ≤ 50 nmol/l se asociaron a enfermedad coronaria multivaso (RR: 2,6 [IC 95%: 1,1-7,1], p = 0,027) y 25(OH)D ≤ 50nmol/l + paratohormona ≥ 65pg/ml identificaron a pacientes con mayor riesgo de MACE (RR: 4 [IC 95%: 1,1-21,8], p = 0,04). Se registro un MACE en el grupo de pacientes suplementados y 5 en el de tratamiento convencional (p = 0,66). Entre los pacientes con niveles sericos de 25(OH)D ≤ 50 nmol/l al final del estudio el 28,6% presentaron MACE frente al 0% si los niveles eran > 50 nmol/l (RR: 1,4; p = 0,037). Conclusiones El deficit de vitamina D que implica un hiperparatiroidismo secundario puede ser un buen predictor de MACE. En pacientes suplementados con calcifediol se observo una tendencia a la disminucion de MACE en el seguimiento. Niveles finales de 25(OH)D ≤ 50 nmol/l se asociaron significativamente a un mayor numero de MACE, por lo que la normalizacion de 25(OH)D, ademas de mejorar la salud osea, puede mejorar la salud cardiovascular.

Background and objectives Vitamin D deficiency has been consistently linked with cardiovascular diseases. However, results of intervention studies are contradictory. The aim of this study was to evaluate the effect of treatment with calcifediol (25(OH)D3) on the cardiovascular system of patients with non-ST-elevation acute coronary syndrome after percutaneous coronary intervention. Patients and methods A prospective study assessing ≥60-year-old patients with non-ST-elevation acute coronary syndrome, coronary artery disease and percutaneous revascularisation. We randomly assigned 41 patients (70.6 ±6.3 years) into 2 groups: Standard treatment + 25(OH)D3 supplementation or standard treatment alone. Major adverse cardiovascular events (MACE) were evaluated at the conclusion of the 3-month follow-up period. 25(OH)D levels were analyzed with regard to other relevant analytical variables and coronary disease extent. Results Basal levels of 25(OH)D ≤ 50 nmol/L were associated with multivessel coronary artery disease (RR: 2.6 [CI 95%:1.1–7.1], p =0.027) and 25(OH)D ≤ 50 nmol/L + parathormone ≥ 65 pg/mL levels correlated with increased risk for MACE (RR: 4 [CI 95%: 1.1–21.8], p = 0.04]. One MACE was detected in the supplemented group versus five in the control group (p = 0.66). Among patients with 25(OH)D levels ≤50 nmol/L at the end of the study, 28.6% had MACE versus 0% among patients with 25(OH)D > 50 nmol/L (RR: 1,4; p = 0.037). Conclusions Vitamin D deficiency plus secondary hyperparathyroidism may be an effective predictor of MACE. A trend throughout the follow up period towards a reduction in MACE among patients supplemented with 25(OH)D3 was detected. 25(OH)D levels ≤ 50 nmol/L at the end of the intervention period were significantly associated with an increased number of MACE, hence, 25(OH)D level normalization could improve cardiovascular health in addition to bone health.