Dietary Intake of Menaquinone Is Associated with a Reduced Risk of Coronary Heart Disease: The Rotterdam Study

In this observational study of 4,807 Dutch adults aged 55 and over, those eating the most dietary menaquinone had a lower rate of coronary heart disease death than those eating the least (relative risk 0.43, 95% CI 0.24 to 0.77). No supplement was tested.
Summary

Researchers followed 4,807 Dutch men and women aged 55 and over for about seven years and compared how much vitamin K1 and vitamin K2 they ate with heart disease that developed later. People eating the most vitamin K2 had fewer deaths from coronary heart disease, lower all-cause mortality, and less severe calcification of the aorta. Vitamin K1 intake was not linked to any of these outcomes.

Context Note
No DOI is printed on this paper. Observational study, so it shows an association and not cause and effect.

Study breakdown

Why this study was done

Vitamin K is best known for its part in blood clotting. It also switches on proteins outside the liver, including matrix Gla-protein, found in artery walls, which appears to hold back calcium deposits. Calcium in the artery wall is linked to heart disease. Vitamin K comes in two dietary forms: phylloquinone, or vitamin K-1, mainly from green vegetables and vegetable oils, and menaquinone, or vitamin K-2, which here came mainly from meat, eggs, cheese and dairy. The researchers asked whether people eating more of either form had less artery calcification and fewer coronary events.

How it was run

This was an observational analysis inside the Rotterdam Study, a population cohort of older people in one district of Rotterdam in the Netherlands. It included 4807 men and women aged 55 and over with dietary data and no history of heart attack at the 1990 to 1993 baseline. Diet was recorded with a validated food frequency questionnaire and a dietitian interview, and vitamin K in Dutch foods was measured by laboratory analysis. Follow-up ran to 1 January 2000, a mean of 7.2 years (SD 1.9), giving 34,645 person-years. Calcium in the abdominal aorta was graded at baseline from lumbar spine X-rays in 4473 people. Intakes were adjusted for energy and split into thirds. Results were adjusted for age, gender, energy, body mass index, smoking, pack-years, diabetes, education, alcohol, saturated fat, polyunsaturated fat, flavonols and calcium. Nobody was given a supplement.

What they found

There were 144 first non-fatal heart attacks, 99 fatal coronary events and 602 other deaths. Median menaquinone intakes across the three groups were 15.1, 26.9 and 40.9 micrograms a day. Comparing the middle and top thirds with the bottom third:

  • Coronary heart disease: relative risk 0.96 (95% CI 0.70 to 1.31) and 0.59 (0.40 to 0.86), P for trend 0.007.
  • Coronary death: 0.73 (0.45 to 1.17) and 0.43 (0.24 to 0.77).
  • Death from any cause: 0.91 (0.75 to 1.09) and 0.74 (0.59 to 0.92).
  • Severe aortic calcification, 5 cm or more: odds ratio 0.71 (0.50 to 1.00) and 0.48 (0.32 to 0.71).
  • Moderate calcification: no association, 0.91 and 0.93.
  • Non-fatal heart attack alone: 1.08 and 0.67 (0.41 to 1.09), not statistically significant.

Phylloquinone was not linked to any outcome. Its adjusted relative risks for coronary death were 0.90 and 1.02.

Limitations

This is an observational cohort, so it cannot establish cause. Diet was measured once, by questionnaire, and people misreport what they eat. Menaquinone intake tracked with total fat, saturated fat, dietary calcium, body mass index and diabetes, so residual confounding is possible. Funding came from the Health Research and Development Council in The Hague, a public body, and no supplement company funding is declared. Two co-authors worked at the laboratory that produced the vitamin K food values used to define the exposure, so measurement and analysis were not independent. Aortic calcification was scored from a plain lower spine X-ray, a proxy rather than a direct look at the coronary arteries. The authors note that gut bacteria also produce menaquinone, which could not be quantified.

What it means in practice

This studied habitual food intake in an elderly Dutch population. It was not a trial. It links eating more menaquinone-containing foods to lower rates of coronary events and severe aortic calcification in that group. It does not show that vitamin K caused the difference, and it does not automatically extend to younger or healthier people. No supplement was given here, so the study says nothing about what a vitamin K supplement would do. The phylloquinone result is a plain null.

Study Type
Cohort Study
Published
2004
The Journal of Nutrition
Participants
4,807 Dutch adults aged 55 and over, mean follow-up 7.2 years
Dose Studied
Not applicable, dietary intake study
Health Focus
No items found.
Ingredients
Vitamin K2

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