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Study finds vitamin D may be an indicator of poor coronary collateral circulation in patients with coronary blockage

Posted on: February 9, 2016   by  Riley Peterson & John Cannell, MD.


A recent study found that low vitamin D levels may be an indicator of poor coronary collateral circulation in patients with coronary chronic total occlusion.

Coronary artery chronic total occlusion (CTO) is the complete or nearly complete blockage of a coronary artery for 30 days or longer. Coronary collateral circulation (CCC) is the re-routing of blood vessels around a blocked artery via nearby minor vessels. The symptoms of CCC include chest pain, jaw pain, dizziness, fatigue and irregular heartbeat.

It plays a vital role in patients with CTO, providing an alternative route for blood flow. Having well developed CCC is important for one’s health, and can reduce the risk of dangerous health outcome, such as strokes or heart attacks.

Vitamin D status is associated with several cardiovascular diseases, including hypertension, coronary artery disease (CAD) and cardiovascular mortality. There has been limited research regarding the relationship between vitamin D and CCC. Since CCC is such an important function in the cardiovascular system for overall heart health, the role of vitamin D in this condition is worth investigating.

In a recent study, researchers explored the association between vitamin D and the development of CCC in patients with CTO. This study included 188 patients with CTO in at least one of the coronary arteries. The researchers split the patients in to two groups based on their Rentrop scores, a tool used to indicate the severity of damage to the CCC function. Group 1 included 68 patients with poor CCC, while the 120 individuals placed in to group 2 all had well developed CCC.

The researchers measured serum 25(OH)D levels and high-sensitivity C reactive protein (hs-CRP), a general marker for inflammation that has been known to increase the risk of cardiovascular disease, in order to determine whether or not they could find a relationship to CCC in patients with CTO.

Here is what the researchers found:

  • Patients with poorly developed CCC had significantly lower serum 25 (OH)D levels compared to those with well-developed CCC (20 ±3 vs. 30 ±6 ng/ml, p < 0.0001).
  • The results demonstrated a significant correlation between vitamin D levels and CCC damage (p < 0.001).
  • Serum 25(OH)D levels as well as hs-CRP were determined to be independent predictors of poor CCC in patients with CTO.

The researchers concluded,

“The present study shows that patients with a CTO and poor CCC have lower serum 25(OH)D levels compared to those with well-developed CCC.”

They continued,

“Our study also shows that, in patients with a CTO, low serum 25(OH)D level is an independent predictor of poor CCC. According to our results, we speculate that blunted collaterals might be a cause of poor cardiovascular outcomes in patients with CAD and vitamin D deficiency.”

While this study did show that vitamin D and hs-CRP could be important predictors for CCC in patients with CTO, the cross-sectional design limited the strength of the findings. The study noted that poor overall health may have been a large contributing factor to decreased CCC. The researchers suggested that clinical trials are needed to fully determine the relationship between vitamin D and CCC.


Peterson, R. & Cannell, JJ. Study finds vitamin D may be an indicator of poor coronary collateral circulation in patients with chronic total occlusion. The Vitamin D Council Blog & Newsletter, February, 2016.


Sarli, et al. 25-Hydroxy-vitamin D level may predict presence of coronary collaterals in patients with chronic coronary total occlusion. Advances in Interventional Cardiology, 2015.

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