Carboxylation of circulating matrix Gla protein reflects its capacity to inhibit calcification in the vasculature and is associated with coronary heart disease and mortality.

Vitamin K is required for more carboxylation (activation) of vitamin K-dependent proteins such as matrix Gla protein (MGP) and osteocalcin (bone Gla protein). However, the potential role of other nutrient insufficiencies such as vitamin K received less attention. In this context, vitamin D gained much research interest. Nutritional deficiencies have been recognized as important contributors to disease and increased mortality. Future studies should investigate the effect of combined vitamin D and K supplementation on clinical outcomes. ConclusionsĬombined low vitamin D and K status are associated with increased all-cause mortality risk and possibly with cardiovascular mortality and cardiovascular events compared with adequate vitamin D and K status. We observed similar trends, albeit non-significant for cardiovascular mortality, and cardiovascular events: 1.42 (0.79–2.55), 1.28 (0.93–1.77), respectively. Combined low vitamin D and K status was present in 970 participants (20%) and was associated with a greater risk of all-cause mortality compared to high vitamin D and high vitamin K status group ( n = 1424) after adjusting for potential confounders: hazard ratio 1.46 (95% confidence intervals 1.12–1.90). During a median of 14.2 year follow-up, 620 participants died of which 142 were due to cardiovascular causes. Cause of death was coded according to International Classification of Diseases 9&10 codes from the 2001-2003 examination until date of death/event or censoring date (January 1st, 2017). Patients were categorized into: 25(OH)D 75 nmol/L and dp-ucMGP < 361 pmol/L as reference. At baseline, vitamin D and K status was determined by measurement of 25-hydroxyvitamin D and dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP), respectively. We studied 4742 participants of the Prevention of REnal and Vascular ENd-Stage Disease (PREVEND) Study. To explore the association of both plasma vitamin D and K concentrations with all-cause mortality, cardiovascular mortality, and cardiovascular events in the general population.

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