Slow Coronary Flow and the Serum Vitamin D Level

Document Type : Original Article


1 Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, IR Iran.

2 Community Medicine, Social Determinants of Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran.


Background: Several studies have demonstrated an association between vitamin D deficiency and cardiovascular diseases. Slow coronary flow (SCF) is a phenomenon in coronary angiography defined as the slow (delayed) opacification of the epicardial coronary arteries with contrast agents in the absence of coronary obstruction. We sought to evaluate the level of vitamin D in SCF patients against normal coronary conditions.
Methods: This cross-sectional study was carried out on 164 patients admitted for elective coronary angiography. For 15 months, from among these patients, 82 patients with SCF and 82 patients with normal coronary arteries or mild coronary artery disease (CAD) who were matched for age and gender were selected and vitamin D levels were measured accordingly.
Results: The mean age of the patients was 56 years in the normal coronary group and 54 years in the SCF group. The mean level of vitamin D was 23.84 ng/mL in the normal coronary group and 24.29 ng/mL in the SCF group. Vitamin D deficiency was observed in 44.4% of the patients in the normal coronary group and 41.2% of the patients in the SCF group. The Mann–Whitney U test showed no significant difference between the 2 groups in terms of vitamin D levels (P = 0.96).
Conclusions: The level of vitamin D was not significantly different between our 2 groups of patients with SCF and with normal coronary arteries (or mild CAD).


1. Dogan Y, Sarli B, Baktir AO, Kurtul S, Akpek
M, Sahin O, et al. 25-Hydroxy-vitamin D level
may predict presence of coronary collaterals in
patients with chronic coronary total occlusion.
Advances in Interventional Cardiology.
2. Lugg ST, Howells PA, Thickett DR. Optimal
Vitamin D Supplementation Levels for
Cardiovascular Disease Protection. Disease
Markers. 2015;2015:1-10.
3. Oz F, Cizgici AY, Oflaz H, Elitok A, Karaayvaz
EB, Mercanoglu F, et al. Impact of vitamin D
insufficiency on the epicardial coronary flow
velocity and endothelial function. Coronary
Artery Disease. 2013;24(5):392-7.
4. Mostafavi A, Jafarnejad S, Khavandi S,
Tabatabaee SA. Effect of Vitamin D Deficiency
on Coronary Artery Stenosis. Iranian Heart
Journal. 2015;16 (3):38-44.
5. Akin F, Ayça B, Köse N, Duran M, Sarı M,
Uysal OK, et al. Serum Vitamin D Levels Are
Independently Associated With Severity of
Coronary Artery Disease. Journal of
Investigative Medicine. 2012;60(6):869-73.
6. 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.
7. 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.
8. Liew JY, Sasha SR, Ngu PJ, Warren JL, Wark J,
Dart AM, et al. Circulating vitamin D levels are
associated with the presence and severity of
coronary artery disease but not peripheral
arterial disease in patients undergoing coronary
angiography. Nutrition, Metabolism and
Cardiovascular Diseases. 2015;25(3):274-9.
9. Mandarino NR, Júnior FdCM, Salgado JVL,
Lages JS, Filho NS. Is Vitamin D Deficiency a
New Risk Factor for Cardiovascular Disease?
The Open Cardiovascular Medicine Journal.

10. Gondim F, Caribé A, Vasconcelos KF, Segundo
AD, Bandeira F. Vitamin D Deficiency is
Associated with Severity of Acute Coronary
Syndrome in Patients with Type 2 Diabetes and
High Rates of Sun Exposure. Clinical Medicine
Insights: Endocrinology and Diabetes.
11. Ford JA, MacLennan GS, Avenell A, Bolland
M, Grey A, Witham M. Cardiovascular disease
and vitamin D supplementation: trial analysis,
systematic review, and meta-analysis. The
American Journal of Clinical Nutrition.
12. Parham M, Mohammadi SM, Bagherzadeh M,
Hosseinzadeh F, Eshraghi M, Bakhtiari L, et al.
A Comparison of the Relationship between the
Serum Level of Vitamin D and Coronary Artery
Disease in Patients with Type 2 Diabetes. Qom
Univ Med Sci J. 2014;8(4):13-8.
13. Bamanikar A, Bhumika V, Dhobale S, Rathore
V, Bamanikar S. Prospective study of
hypovitaminosis D in acute coronary syndrome.
The Journal of Medical Research.
14. Rashidinejad HR, Amanollahi F, Safizadeh H,
Moazenzadeh M. Serum Vitamin D Level and
Hypertensive Crises. J Cardiothorac Med.
15. Altun I, Akin F, Kose N, Sahin C, Kirli I.
Predictors of slow flow in angiographically
normal coronary arteries. Int J Clin Exp Med
16. Kalay N. The relationship between
inflammation and slow coronary flow: increased
red cell distribution width and serum uric acid
levels. Turk Kardiyoloji Dernegi ArsiviArchives of the Turkish Society of Cardiology.
17. Ghaffari S, Tajlil A, Aslanabadi N, Separham A,
Sohrabi B, Saeidi G, et al. Clinical and
laboratory predictors of coronary slow flow in
coronary angiography. Perfusion.
18. Oktay V, Arat Özkan A. Coronary slow flow.
Turk kardiyol Dern Ars. 2016;44(3):193-5.
19. Bugiardini R, Badimon L, Collins P, Erbel R,
Fox K, Hamm C, et al. Angina, “Normal”
Coronary Angiography, and Vascular
Dysfunction: Risk Assessment Strategies. PLoS
Medicine. 2007;4(2):e12.
20. Vatandost S, Jahani M, Afshari A, Amiri MR,
Heidarimoghadam R, Mohammadi Y.
Prevalence of vitamin D deficiency in Iran: A
systematic review and meta-analysis. Nutrition
and Health. 2018;24(4):269-78.
21. Moazenzadeh M, Sarvar Azimzadeh B, Zare J,
Shokouhi M, Sheikhvatan M. Clinical Features
and Main Determinants of Coronary Slow Flow
Phenomenon in Iranian Patients. European
Journal of Cardiovascular Medicine.
22. Thomas GN, o Hartaigh B, Bosch JA, Pilz S,
Loerbroks A, Kleber ME, et al. Vitamin D
Levels Predict All-Cause and Cardiovascular
Disease Mortality in Subjects With the
Metabolic Syndrome: The Ludwigshafen Risk
and Cardiovascular Health (LURIC) study.
Diabetes Care. 2012;35(5):1158-64.
23. Khazaei Z, Khazaei S, Beigrezaei S, Nasri H.
Vitamin D deficiency in healthy people and its
relationship with gender and age. Journal of
Parathyroid Disease. 2017;6(1):16-8.
24. Aljefree N, Lee P, Alsaqqaf J, Ahmed F.
Association between Vitamin D Status and
Coronary Heart Disease among Adults in Saudi
Arabia: A Case-Control Study. Healthcare.
25. Chitalia N, Recio-Mayoral A, Kaski JC,
Banerjee D. Vitamin D deficiency and
endothelial dysfunction in non-dialysis chronic
kidney disease patients. Atherosclerosis.
26. Dalan R, Liew H, Tan WKA, Chew DEK, Leow
MK-S. Vitamin D and the endothelium: basic,
translational and clinical research updates. IJC
Metabolic & Endocrine. 2014;4:4-17.