Vitamin D Deficiency and Its Association With Hypertension and Dyslipidemia in a Resource-Limited Cardiovascular Clinic Cohort in Yemen: A Cross-Sectional Analysis

TL;DR

This study finds that vitamin D deficiency is linked to hypertension and poor cholesterol levels in a Yemeni clinic population, emphasizing the need for better screening and management in resource-limited areas.

Contribution

The study identifies specific cardiometabolic risk factors associated with vitamin D deficiency in a resource-limited Yemeni cohort.

Findings

36.6% of the cohort had vitamin D deficiency, with hypertriglyceridemia increasing deficiency odds by 89%.

Hypertension was associated with a 61% increased odds of vitamin D deficiency.

Elevated HDL-C reduced the odds of deficiency by 59%.

Abstract

Background: Vitamin D deficiency is a prevalent public health issue that disproportionately affects populations in resource-limited regions, even in the presence of abundant sunlight. Cultural practices and healthcare system limitations across the Middle East contribute to elevated rates of deficiency, which, in turn, worsen the burden of cardiometabolic diseases. This study aims to assess the prevalence of vitamin D deficiency and explore its association with hypertension and dyslipidemia in a clinical cohort from Yemen - a setting where diagnostic challenges complicate disease management.

Patients and methods: A retrospective cross-sectional study was implemented, enrolling 404 adult patients who attended a tertiary cardiovascular clinic at Ibb University, Ibb, Yemen, from January to December 2023. Serum 25-hydroxyvitamin D (25(OH)D) and fasting lipid parameters were measured. Vitamin D status was classified per Endocrine Society guidelines as deficient (<20 ng/mL), insufficient (20-29 ng/mL), or sufficient (≥30 ng/mL). Both multivariable linear and logistic regression analyses were utilized to determine independent predictors of vitamin D status, adjusting for demographic and clinical variables, including age, sex, hypertension, and lipid parameters.

Results: The study cohort had a mean age of 43.0 ± 16.0 years, with females comprising 52.5% (n = 212). Hypertension was present in 45.8% (n = 185) of participants. Vitamin D status classification revealed that 36.6% (n = 148) of the cohort were deficient, 31.2% (n = 126) insufficient, and 32.2% (n = 130) had sufficient vitamin D levels. Adjusted multivariate analyses indicated that hypertriglyceridemia (≥200 mg/dL) was associated with an 89% increased odds of vitamin D deficiency (adjusted odds ratio (aOR) = 1.89; 95% confidence interval (CI), 1.09-3.28; p = 0.024), while hypertension conferred a 61% increase in the odds of deficiency (aOR = 1.61; 95% CI, 1.04-2.50; p = 0.034). Elevated high-density lipoprotein cholesterol (HDL-C) (≥60 mg/dL) exhibited a protective effect against deficiency (aOR = 0.41; 95% CI, 0.20-0.84; p = 0.015). Furthermore, each 10-year increment in age was associated with a 22% higher likelihood of vitamin D deficiency (aOR = 1.22; 95% CI, 1.00-1.48; p = 0.015).

Conclusion: In this resource-constrained Yemeni clinical cohort, vitamin D deficiency is independently associated with hypertriglyceridemia, low HDL-C, and hypertension. These findings underscore the importance of targeted vitamin D screening and integrated cardiometabolic risk management strategies within similar vulnerable populations, and highlight the need for further longitudinal studies to explore causality.