A retrospective study on the associations of serum 25-hydroxyvitamin D with N-terminal pro-B-type natriuretic peptide and left ventricular ejection fraction in patients with type 2 diabetes mellitus
4 affiliations
- 1Department of Endocrinology, The People’s Hospital of Jimo
- 2Department of Clinical Laboratory, The People’s Hospital of Jimo
- 3Department of Clinical Nutrition, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University
- 4Department of Endocrinology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University
Abstract
Background: Accumulating evidence points to a role of vitamin D deficiency in cardiovascular diseases. However, its implications for cardiac dysfunction, particularly in patients with type 2 diabetes mellitus (T2DM), have not been well defined. In the present study, the relationships between serum 25-hydroxyvitamin D (25(OH)D) and markers for cardiac dysfunction were investigated.
Methods: This retrospective study enrolled 601 participants (210 males, 391 females) with T2DM, aged ≥18 years. Patients with a history of vitamin D supplementation, hyper-/hypoparathyroidism, or incomplete data were excluded. Correlation analyses were conducted to explore the associations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) with serum 25(OH)D and related clinical indexes. Multivariate logistic regression analysis was performed to explore the association between vitamin D deficiency and elevated NT-proBNP. Causal mediation analyses were performed to examine the potential mediating role of urinary microalbumin-to-creatinine ratio (UACR) in the association between vitamin D deficiency and NT-proBNP. A directed acyclic graph (DAG) was constructed to identify confounders for multivariable adjustment and distinguish mediators.
Results: Of all subjects, 143 (24%) presented vitamin D deficiency and 221 (36.8%) presented vitamin D insufficiency. Elevated NT-proBNP was detected in 266 (44.3%) patients. In patients with vitamin D deficiency, NT-proBNP level was significantly increased compared with those with vitamin D sufficiency or those with vitamin D insufficiency, but LVEF showed no differences among groups. Multivariate logistic regression analysis showed that the odds ratio (OR) for elevated NT-proBNP in patients with vitamin D deficiency was 2.11 (95% CI 1.38-3.2, P < 0.001) versus patients with vitamin D sufficiency. After adjusting for age, sex, BMI, diabetes duration, hypertension, coronary heart disease, HbA1c, and eGFR, the association between vitamin D deficiency and elevated NT-proBNP remained significant (OR 1.833, 95% CI 1.115-3.013, P = 0.017). Mediation analysis revealed that approximately 43.23% of the total effect was statistically compatible with an indirect pathway through UACR.
Conclusions: Vitamin D deficiency was associated with elevated NT-proBNP, a marker of myocardial wall stress that may signal early cardiac involvement, whereas no association with LVEF was observed. This association was partially accounted for by UACR in exploratory mediation analyses.
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BibTeX
@article{shao2026retrospective,
title = {{A retrospective study on the associations of serum 25-hydroxyvitamin D with N-terminal pro-B-type natriuretic peptide and left ventricular ejection fraction in patients with type 2 diabetes mellitus}},
author = {Yuting Shao and Shasha Shi and Yifei Li and Guangyi Gao and Xuelin Feng and Minghui Li and Yuantao Liu and Yonggang Song},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1943266},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1943266/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A retrospective study on the associations of serum 25-hydroxyvitamin D with N-terminal pro-B-type natriuretic peptide and left ventricular ejection fraction in patients with type 2 diabetes mellitus
AU - Yuting Shao
AU - Shasha Shi
AU - Yifei Li
AU - Guangyi Gao
AU - Xuelin Feng
AU - Minghui Li
AU - Yuantao Liu
AU - Yonggang Song
PY - 2026
DA - 2026/10/28
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1943266
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1943266/full
AB - Background: Accumulating evidence points to a role of vitamin D deficiency in cardiovascular diseases. However, its implications for cardiac dysfunction, particularly in patients with type 2 diabetes mellitus (T2DM), have not been well defined. In the present study, the relationships between serum 25-hydroxyvitamin D (25(OH)D) and markers for cardiac dysfunction were investigated. Methods: This retrospective study enrolled 601 participants (210 males, 391 females) with T2DM, aged ≥18 years. Patients with a history of vitamin D supplementation, hyper-/hypoparathyroidism, or incomplete data were excluded. Correlation analyses were conducted to explore the associations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) with serum 25(OH)D and related clinical indexes. Multivariate logistic regression analysis was performed to explore the association between vitamin D deficiency and elevated NT-proBNP. Causal mediation analyses were performed to examine the potential mediating role of urinary microalbumin-to-creatinine ratio (UACR) in the association between vitamin D deficiency and NT-proBNP. A directed acyclic graph (DAG) was constructed to identify confounders for multivariable adjustment and distinguish mediators. Results: Of all subjects, 143 (24%) presented vitamin D deficiency and 221 (36.8%) presented vitamin D insufficiency. Elevated NT-proBNP was detected in 266 (44.3%) patients. In patients with vitamin D deficiency, NT-proBNP level was significantly increased compared with those with vitamin D sufficiency or those with vitamin D insufficiency, but LVEF showed no differences among groups. Multivariate logistic regression analysis showed that the odds ratio (OR) for elevated NT-proBNP in patients with vitamin D deficiency was 2.11 (95% CI 1.38-3.2, P < 0.001) versus patients with vitamin D sufficiency. After adjusting for age, sex, BMI, diabetes duration, hypertension, coronary heart disease, HbA1c, and eGFR, the association between vitamin D deficiency and elevated NT-proBNP remained significant (OR 1.833, 95% CI 1.115-3.013, P = 0.017). Mediation analysis revealed that approximately 43.23% of the total effect was statistically compatible with an indirect pathway through UACR. Conclusions: Vitamin D deficiency was associated with elevated NT-proBNP, a marker of myocardial wall stress that may signal early cardiac involvement, whereas no association with LVEF was observed. This association was partially accounted for by UACR in exploratory mediation analyses.
SN - 1664-2392
ER -