Document Type : Original Article(s)


1 Associate Professor, Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Resident, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Associate Professor, Psychosomatic Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

5 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

6 Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: Vitamin D deficiency is a prevalent condition in Iran and previous studies have shown that a low level of serum vitamin D is related to low ankle-brachial index (ABI). In the present study, the relationship of the serum level of vitamin D with ABI, as an index for atherosclerosis of peripheral arteries, was evaluated.METHODS: In this cross-sectional study, data on 91 patients with metabolic syndrome (Mets) from the Isfahan Cohort Study (ICS) were analyzed in order to evaluate the association between serum 25(OH) vitamin D level and ABI. The participants were divided into two groups; group A with desirable serum vitamin D level and group B with abnormal serum vitamin D level. ABI was measured and compared between these groups.RESULTS: A crude and adjusted model showed no association between vitamin D level and ABI in patients with MetS.CONCLUSION: It can be concluded that serum vitamin D level could not affect ABI in patients with MetS.


  1. Sarrafzadegan N, Kelishadi R, Sadri G, Malekafzali H, Pourmoghaddas M, Heidari K, et al. Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan Healthy Heart Program. Arch Iran Med 2013; 16(1): 4-11.
  2. Scuteri A, Najjar SS, Muller DC, Andres R, Hougaku H, Metter EJ, et al. Metabolic syndrome amplifies the age-associated increases in vascular thickness and stiffness. J Am Coll Cardiol 2004; 43(8): 1388-95.
  3. Tomiyama H, Hirayama Y, Hashimoto H, Yambe M, Yamada J, Koji Y, et al. The effects of changes in the metabolic syndrome detection status on arterial stiffening: A prospective study. Hypertens Res 2006; 29(9): 673-8.
  4. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98(8): 731-3.
  5. Roohafza H, Sadeghi M, Sarraf-Zadegan N, Baghaei A, Kelishadi R, Mahvash M, et al. Short communication: Relation between stress and other life style factors. Stress and Health 2007; 23: 23-9.
  6. Khosravi-Boroujeni H, Sarrafzadegan N, Sadeghi M, Roohafza H, Ng SK, Pourmogaddas A, et al. Prevalence and trends of vitamin D deficiency among Iranian adults: A longitudinal study from 2001-2013. J Nutr Sci Vitaminol (Tokyo) 2017; 63(5): 284-90.
  7. Kayaniyil S, Vieth R, Retnakaran R, Knight JA, Qi Y, Gerstein HC, et al. Association of vitamin D with insulin resistance and beta-cell dysfunction in subjects at risk for type 2 diabetes. Diabetes Care 2010; 33(6): 1379-81.
  8. Makariou S, Liberopoulos EN, Elisaf M, Challa A. Novel roles of vitamin D in disease: What is new in 2011? Eur J Intern Med 2011; 22(4): 355-62.
  9. Adragao T, Pires A, Branco P, Castro R, Oliveira A, Nogueira C, et al. Ankle-brachial index, vascular calcifications and mortality in dialysis patients. Nephrol Dial Transplant 2012; 27(1): 318-25.
  10. Hosseini N, Talaei M, Dianatkhah M, Sadeghi M, Oveisgharan S, Sarrafzadegan N. Determinants of incident metabolic syndrome in a middle eastern population: Isfahan Cohort Study. Metab Syndr Relat Disord 2017; 15(7): 354-62.
  11. Sarrafzadegan N, Gharipour M, Sadeghi M, Khosravi AR, Tavassoli AA. Metabolic syndrome in Iranian elderly. ARYA Atheroscler 2012; 7(4): 157-61.
  12. Pasqualini L, Schillaci G, Pirro M, Vaudo G, Leli C, Colella R, et al. Prognostic value of low and high ankle-brachial index in hospitalized medical patients. Eur J Intern Med 2012; 23(3): 240-4.
  13. Bouchi R, Babazono T, Takagi M, Yoshida N, Nyumura I, Toya K, et al. Non-linear association between ankle-brachial pressure index and prevalence of silent cerebral infarction in Japanese patients with type 2 diabetes. Atherosclerosis 2012; 222(2): 490-4.
  14. Hsu PF, Chuang SY, Cheng HM, Tsai ST, Chou P, Chen CH. Clinical significance of the metabolic syndrome in the absence of established hypertension and diabetes: A community-based study. Diabetes Res Clin Pract 2008; 79(3): 461-7.
  15. Lin YC, Hsiao TJ, Chen PC. Persistent rotating shift-work exposure accelerates development of metabolic syndrome among middle-aged female employees: A five-year follow-up. Chronobiol Int 2009; 26(4): 740-55.
  16. Sadeghi M, Talaei M, Oveisgharan S, Rabiei K, Dianatkhah M, Bahonar A, et al. The cumulative incidence of conventional risk factors of cardiovascular disease and their population attributable risk in an Iranian population: The Isfahan Cohort Study. Adv Biomed Res 2014; 3: 242.
  17. Sadeghi M, Heidari R, Mostanfar B, Tavassoli A, Roghani F, Yazdekhasti S. The relation between ankle-brachial index (ABI) and coronary artery disease severity and risk factors: An angiographic study. ARYA Atheroscler 2011; 7(2): 68-73.
  18. Wild SH, Byrne CD, Tzoulaki I, Lee AJ, Rumley A, Lowe GD, et al. Metabolic syndrome, haemostatic and inflammatory markers, cerebrovascular and peripheral arterial disease: The Edinburgh Artery Study. Atherosclerosis 2009; 203(2): 604-9.
  19. Conen D, Rexrode KM, Creager MA, Ridker PM, Pradhan AD. Metabolic syndrome, inflammation, and risk of symptomatic peripheral artery disease in women: A prospective study. Circulation 2009; 120(12): 1041-7.
  20. Saedisomeolia A, Taheri E, Djalali M, Moghadam AM, Qorbani M. Association between serum level of vitamin D and lipid profiles in type 2 diabetic patients in Iran. J Diabetes Metab Disord 2014; 13(1): 7.
  21. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the third national health and nutrition examination survey. Am J Hypertens 2007; 20(7): 713-9.
  22. Rostand SG. Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension 1997; 30(2 Pt 1): 150-6.
  23. Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab 2001; 86(4): 1633-7.
  24. Scragg R, Khaw KT, Murphy S. Effect of winter oral vitamin D3 supplementation on cardiovascular risk factors in elderly adults. Eur J Clin Nutr 1995; 49(9): 640-6.
  25. Chonchol M, Scragg R. 25-Hydroxyvitamin D, insulin resistance, and kidney function in the Third National Health and Nutrition Examination Survey. Kidney Int 2007; 71(2): 134-9.
  26. Ford ES, Ajani UA, McGuire LC, Liu S. Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults. Diabetes Care 2005; 28(5): 1228-30.
  27. Poole KE, Loveridge N, Barker PJ, Halsall DJ, Rose C, Reeve J, et al. Reduced vitamin D in acute stroke. Stroke 2006; 37(1): 243-5.
  28. Zittermann A, Schleithoff SS, Tenderich G, Berthold HK, Korfer R, Stehle P. Low vitamin D status: A contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 2003; 41(1): 105-12.
  29. Rajasree S, Rajpal K, Kartha CC, Sarma PS, Kutty VR, Iyer CS, et al. Serum 25-hydroxyvitamin D3 levels are elevated in South Indian patients with ischemic heart disease. Eur J Epidemiol 2001; 17(6): 567-71.
  30. Scragg R, Jackson R, Holdaway IM, Lim T, Beaglehole R. Myocardial infarction is inversely associated with plasma 25-hydroxyvitamin D3 levels: A community-based study. Int J Epidemiol 1990; 19(3): 559-63.
  31. Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117(4): 503-11.
  32. O'Connell TD, Simpson RU. Immunochemical identification of the 1,25-dihydroxyvitamin D3 receptor protein in human heart. Cell Biol Int 1996; 20(9): 621-4.
  33. Xiang W, Kong J, Chen S, Cao LP, Qiao G, Zheng W, et al. Cardiac hypertrophy in vitamin D receptor knockout mice: Role of the systemic and cardiac renin-angiotensin systems. Am J Physiol Endocrinol Metab 2005; 288(1): E125-E132.
  34. Bodyak N, Ayus JC, Achinger S, Shivalingappa V, Ke Q, Chen YS, et al. Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals. Proc Natl Acad Sci U S A 2007; 104(43): 16810-5.
  35. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25 Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002; 110(2): 229-38.
  36. Timms PM, Mannan N, Hitman GA, Noonan K, Mills PG, Syndercombe-Court, et al. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: Mechanisms for inflammatory damage in chronic disorders? QJM 2002; 95(12): 787-96.
  37. Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: A double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2006; 83(4): 754-9.
  38. Kasuga H, Hosogane N, Matsuoka K, Mori I, Sakura Y, Shimakawa K, et al. Characterization of transgenic rats constitutively expressing vitamin D-24-hydroxylase gene. Biochem Biophys Res Commun 2002; 297(5): 1332-8.