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Interaction of Factors Related to the Metabolic Syndrome and Vitamin D on Risk of Prostate Cancer

¹ Medical School, University of Tampere and Department of Clinical Chemistry, Tampere University Hospital; ² School of Public Health, University of Tampere, Tampere, Finland; ³ Helsinki Heart Study; ⁴ Finnish Cancer Registry, Helsinki, Finland; and ⁵ Department of Medical Microbiology, MAS University Hospital, Malmö, Sweden

Requests for reprints: Pentti Tuohimaa, Medical School, University of Tampere, FIN-33014 Tampere, Finland. Phone: 358-3-35516726; Fax: 358-3-35516170. E-mail: Pentti.Tuohimaa{at}uta.fi

Background: Factors related to the metabolic syndrome and low levels of vitamin D have been implicated as risk factors for prostate cancer. Insofar, no studies have assessed their joint effects on prostate cancer risk.

Methods: We studied (a) the associations of vitamin D with the metabolic syndrome factors body mass index, systolic and diastolic blood pressure, and high-density lipoprotein cholesterol (HDL-C) and (b) the prostate cancer risk associated with these factors and especially their joint effects with vitamin D on risk of prostate cancer. We did a longitudinal nested case-control study on 132 prostate cancer cases and 456 matched controls from a cohort of 18,939 Finnish middle-aged men from the Helsinki Heart Study. The odds ratios (OR) of prostate cancer were assessed via conditional logistic regression analysis.

Results: Apart from HDL-C, there was no linear association between the metabolic syndrome factors and vitamin D levels. In univariate analysis, men in the highest quartiles of body mass index (>28 kg/m²) and systolic blood pressure (>150 mmHg) showed a modest increase in risks of prostate cancer, with ORs of 1.37 (P = 0.16) and 1.53 (P = 0.05) when compared with the three lower quartiles, but low HDL-C entailed no prostate cancer risk. However, with all three factors present, the OR was 3.36 (P = 0.02), and jointly with low vitamin D (40 nmol/L), the OR was 8.03 (P = 0.005) compared with those with no metabolic syndrome factors and intermediate levels of vitamin D. There was an interaction between vitamin D and the metabolic syndrome factors so that a clustering of these factors entailed high risk of prostate cancer but only if vitamin D level was low (40 nmol/L). If it was at intermediate levels, the metabolic syndrome factors entailed no prostate cancer risk.

Conclusions: We conclude that the prostate cancer risk associated with factors related to the metabolic syndrome is strongly conditioned by levels of vitamin D. (Cancer Epidemiol Biomarkers Prev 2007;16(2):302–7)

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