Hussein M Ismail,1,2 Abeer S Algrafi,2 Osama Amoudi,3 Sameh Ahmed,4 Sultan S Al-Thagfan,5 Hassan Shora,6 Mohammed Aljohani,7 Mohammed Almutairi,7 Fahad Alharbi,7 Abdullah Alhejaili,7 Majed Alamri,7 Abdullah Muhawish,7 Ayat Abdallah8,9 1Department of cardiology, College of Medicine, Suez Canal University, Ismailia, Egypt; 2Department of medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 3Madinah Cardiac Center, Adult cardiology, Al-Madinah Al-Munawara, Saudi Arabia; 4Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 5Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 6Department of molecular biology/biochemistry, Port Said University, Port Said, Egypt; 7Medical intern, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 8Epidemiology and Preventive Medicine Department, National Liver Institute, Shebin El-Kom, Egypt; 9Department of Family and Community Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi ArabiaCorrespondence: Hussein M IsmailDepartment of Cardiology, College of Medicine, Suez Canal University, Ismailia, EgyptEmail husseinismail@med.suez.edu.eg; drhussein72@gmail.comBackground: Vitamin D deficiency is considered an emerging health problem that affects at least one billion patients worldwide. Calcitriol 1,25(OH)2D3 has several systemic effects, including anti-inflammatory, anti-thrombotic and anti-atherosclerotic impacts that explain its cardioprotective effects. The precise association between vitamin D and its metabolites and the value of supplements in acute coronary syndrome (ACS) is still controversial. This study aims to search the association between vitamin D2, D3, and metabolites and ACS in patients undergoing coronary angiography.Materials and Methods: This was a case–control study on 73 consecutive adult patients with ACS undergoing coronary angiography compared to 50 controls without coronary artery disease and matched for age and sex from June 2019 till July 2019. Echocardiography and coronary angiography were done for all cases. Plasma vitamin D and its metabolites were measured at admission for all participants along with chemistry profiles.Results: Vitamin D and its metabolites were statistically significantly lower in ACS patients than the controls. Multivariate regression analysis revealed that low levels of 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) significantly predicted ACS occurrence; the other significant predictors were high systolic blood pressure (BP), high total cholesterol, and low high-density lipoprotein-cholesterol. Interestingly, vitamin D2 and D3 did not significantly predict ACS (p> 0.05). We did not find a statistically significant association between the number of affected coronary vessels and vitamin D metabolites. Moreover, there was no statistically significant correlation between vitamin D and its metabolites and left ventricular ejection fraction measured by echocardiography.Conclusion: There was a strong association between vitamin D and all its metabolites with ACS. Significantly, low 25(OH)D and 1,25(OH)2D predicted ACS, but vitamin D2 and D3 did not. Large randomized controlled trials are needed to verify the beneficial values of vitamin D supplementation in ACS patients.Keywords: vitamin D3, vitamin D2, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D3, acute coronary syndrome, coronary artery disease
