Diabetol Metab Syndr. 2026 Feb 1. doi: 10.1186/s13098-026-02099-y. Online ahead of print.
ABSTRACT
BACKGROUND: The association between vitamin D status and mortality risk among adults with cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 requires further elucidation. We investigated the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and all-cause and cause-specific mortality among United States adults diagnosed with CKM syndrome stages 0-3.
METHODS: Data from 37,551 adults presenting with CKM syndrome stages 0-3 were examined using National Health and Nutrition Examination Survey records (2001-2018). Death outcomes were determined via National Death Index linkage through December 31, 2019. Cox proportional hazards modeling and two-piecewise Cox regression approaches were utilized to assess nonlinear relationships between serum 25(OH)D levels and mortality risk, incorporating stratified analyses for high-risk population identification.
RESULTS: Throughout 337,921 person-years of observation, we documented 4,039 deaths from all causes, encompassing 1,078 cardiovascular disease (CVD)-related deaths. Following multivariable adjustment, reduced serum 25(OH)D levels demonstrated significant associations with elevated all-cause and CVD mortality risk through nonlinear patterns. L-shaped dose-response curves emerged, revealing mortality risk plateaus at 52.20 nmol/L for all-cause mortality and 53.90 nmol/L for CVD mortality. Individuals maintaining 25(OH)D levels above these threshold values exhibited 2% reduced all-cause mortality risk (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.97-0.99) and 2% decreased CVD mortality risk (HR 0.98, 95% CI 0.97-0.99) relative to participants below these cutoff points.
CONCLUSIONS: Nonlinear relationships between serum 25(OH)D levels and both all-cause and CVD mortality were demonstrated among United States adults with CKM syndrome stages 0-3. These findings warrant confirmation through randomized controlled trials.
PMID:41622215 | DOI:10.1186/s13098-026-02099-y