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Tuñón J, González-Hernández I, Llanos-Jiménez L, Alonso-Martín J, Escudier-Villa JM, Tarín N, Cristóbal C, Sanz P, Pello AM, Aceña Á, Carda R, Orejas M, Tomás M, Beltrán P, Calero Rueda M, Marcos E, Serrano-Antolín JM, Gutiérrez-Landaluce C, Jiménez R, Cabezudo J, Curcio A, Peces-Barba G, González-Parra E, Muñoz-Siscart R, González-Casaus ML, Lorenzo A, Huelmos A, Goicolea J, Ibáñez B, Hernández G, Alonso-Pulpón LM, Farré J, Lorenzo Ó, Mahíllo-Fernández I, Egido J. Design and rationale of a multicentre, randomised, double-blind, placebo-controlled clinical trial to evaluate the effect of vitamin D on ventricular remodelling in patients with anterior myocardial infarction: the VITamin D in Acute Myocardial Infarction (VITDAMI) trial. BMJ Open 2016; 6:e011287. [PMID: 27496232 PMCID: PMC4985833 DOI: 10.1136/bmjopen-2016-011287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Decreased plasma vitamin D (VD) levels are linked to cardiovascular damage. However, clinical trials have not demonstrated a benefit of VD supplements on left ventricular (LV) remodelling. Anterior ST-elevation acute myocardial infarction (STEMI) is the best human model to study the effect of treatments on LV remodelling. We present a proof-of-concept study that aims to investigate whether VD improves LV remodelling in patients with anterior STEMI. METHODS AND ANALYSIS The VITamin D in Acute Myocardial Infarction (VITDAMI) trial is a multicentre, randomised, double-blind, placebo-controlled trial. 144 patients with anterior STEMI will be assigned to receive calcifediol 0.266 mg capsules (Hidroferol SGC)/15 days or placebo on a 2:1 basis during 12 months. PRIMARY OBJECTIVE to evaluate the effect of calcifediol on LV remodelling defined as an increase in LV end-diastolic volume ≥10% (MRI). SECONDARY OBJECTIVES change in LV end-diastolic and end-systolic volumes, ejection fraction, LV mass, diastolic function, sphericity index and size of fibrotic area; endothelial function; plasma levels of aminoterminal fragment of B-type natriuretic peptide, galectin-3 and monocyte chemoattractant protein-1; levels of calcidiol (VD metabolite) and other components of mineral metabolism (fibroblast growth factor-23 (FGF-23), the soluble form of its receptor klotho, parathormone and phosphate). Differences in the effect of VD will be investigated according to the plasma levels of FGF-23 and klotho. Treatment safety and tolerability will be assessed. This is the first study to evaluate the effect of VD on cardiac remodelling in patients with STEMI. ETHICS AND DISSEMINATION This trial has been approved by the corresponding Institutional Review Board (IRB) and National Competent Authority (Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)). It will be conducted in accordance with good clinical practice (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use - Good Clinical Practice (ICH-GCP)) requirements, ethical principles of the Declaration of Helsinki and national laws. The results will be submitted to indexed medical journals and national and international meetings. TRIAL REGISTRATION NUMBER NCT02548364; Pre-results.
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Affiliation(s)
- José Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Joaquín Alonso-Martín
- Department of Cardiology, University Hospital of Getafe, Madrid, Spain
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | | | - Nieves Tarín
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | - Carmen Cristóbal
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Petra Sanz
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Cardiology, Hospital Rey Juan Carlos, Madrid, Spain
| | - Ana M Pello
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel Orejas
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Marta Tomás
- Department of Radiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Paula Beltrán
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Esther Marcos
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | | | | | - Rosa Jiménez
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Jorge Cabezudo
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Alejandro Curcio
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Pneumology, Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio González-Parra
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Antonio Lorenzo
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | - Ana Huelmos
- Department of Cardiology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Javier Goicolea
- Department of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Borja Ibáñez
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Luis M Alonso-Pulpón
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Jerónimo Farré
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine, Autónoma University, Madrid, Spain
| | - Óscar Lorenzo
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jesús Egido
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
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52
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Hejazi ME, Modarresi-Ghazani F, Hamishehkar H, Mesgari-Abbasi M, Dousti S, Entezari-Maleki T. The Effect of Treatment of Vitamin D Deficiency on the Level of P-Selectin and hs-CRP in Patients With Thromboembolism: A Pilot Randomized Clinical Trial. J Clin Pharmacol 2016; 57:40-47. [PMID: 27225617 DOI: 10.1002/jcph.774] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/23/2016] [Indexed: 01/21/2023]
Abstract
Despite the known role of vitamin D deficiency in development of thrombosis, no studies have evaluated the impact of treating of vitamin D deficiency on the markers of thrombosis. A pilot randomized clinical trial was done on 40 vitamin D-deficient patients with deep vein thrombosis (DVT) or pulmonary embolism (PE). The intervention group received an oral dose of 50,000 IU vitamin D3 every week for 8 weeks, followed by 1 pearl every 2 weeks for 4 weeks (a total of 3 months), while the control group did not receive vitamin D. Then, P-selectin and hs-CRP were measured at baseline and 1 and 3 months after the intervention. There was no significant decrease in hs-CRP in either group after 1 month (P = .955) or after 3 months (P = .525). Likewise, there was no significant decrease in P-selectin between the 2 groups after 1 month (P = .921) or 3 months (P = .795). The results indicated that treatment of vitamin D deficiency had no significant effect on hs-CRP or P-selectin after 3 months among DVT/PE patients. However, treatment of vitamin D deficiency in these patients resulted in the control of the international normalized ratio (INR) with the lower doses of warfarin. This observation is the first clinical report of enhancement of the anticoagulant effect of warfarin by the supplementing of vitamin D. Larger trials are needed to clearly show the effect of treating of vitamin D deficiency on thrombosis.
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Affiliation(s)
- Mohammad Esmaeil Hejazi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hadi Hamishehkar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Samaneh Dousti
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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53
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Prevalence of 25-hydroxy vitamin D deficiency among type 2 diabetic subjects of South India. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0496-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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54
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Martín-Reyes R, Franco-Peláez JA, Lorenzo Ó, González-Casaus ML, Pello AM, Aceña Á, Carda R, Martín-Ventura JL, Blanco-Colio L, Martín-Mariscal ML, Martínez-Milla J, Villa-Bellosta R, Piñero A, Navarro F, Egido J, Tuñón J. Plasma Levels of Monocyte Chemoattractant Protein-1, n-Terminal Fragment of Brain Natriuretic Peptide and Calcidiol Are Independently Associated with the Complexity of Coronary Artery Disease. PLoS One 2016; 11:e0152816. [PMID: 27171378 PMCID: PMC4865225 DOI: 10.1371/journal.pone.0152816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives We investigated the relationship of the Syntax Score (SS) and coronary artery calcification (CAC), with plasma levels of biomarkers related to cardiovascular damage and mineral metabolism, as there is sparse information in this field. Methods We studied 270 patients with coronary disease that had an acute coronary syndrome (ACS) six months before. Calcidiol, fibroblast growth factor-23, parathormone, phosphate and monocyte chemoattractant protein-1 [MCP-1], high-sensitivity C-reactive protein, galectin-3, and N-terminal pro-brain natriuretic peptide [NT-proBNP] levels, among other biomarkers, were determined. CAC was assessed by coronary angiogram as low-grade (0–1) and high-grade (2–3) calcification, measured with a semiquantitative scale ranging from 0 (none) to 3 (severe). For the SS study patients were divided in SS<14 and SS≥14. Multivariate linear and logistic regression analyses were performed. Results MCP-1 predicted independently the SS (RC = 1.73 [95%CI = 0.08–3.39]; p = 0.040), along with NT-proBNP (RC = 0.17 [95%CI = 0.05–0.28]; p = 0.004), male sex (RC = 4.15 [95%CI = 1.47–6.83]; p = 0.003), age (RC = 0.13 [95%CI = 0.02–0.24]; p = 0.020), hypertension (RC = 3.64, [95%CI = 0.77–6.50]; p = 0.013), hyperlipidemia (RC = 2.78, [95%CI = 0.28–5.29]; p = 0.030), and statins (RC = 6.12 [95%CI = 1.28–10.96]; p = 0.013). Low calcidiol predicted high-grade calcification independently (OR = 0.57 [95% CI = 0.36–0.90]; p = 0.013) along with ST-elevation myocardial infarction (OR = 0.38 [95%CI = 0.19–0.78]; p = 0.006), diabetes (OR = 2.35 [95%CI = 1.11–4.98]; p = 0.028) and age (OR = 1.37 [95%CI = 1.18–1.59]; p<0.001). During follow-up (1.79 [0.94–2.86] years), 27 patients developed ACS, stroke, or transient ischemic attack. A combined score using SS and CAC predicted independently the development of the outcome. Conclusions MCP-1 and NT-proBNP are independent predictors of SS, while low calcidiol plasma levels are associated with CAC. More studies are needed to confirm these data.
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Affiliation(s)
- Roberto Martín-Reyes
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- * E-mail:
| | | | - Óscar Lorenzo
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | | | - Ana María Pello
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - José Luis Martín-Ventura
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | - Luis Blanco-Colio
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Juan Martínez-Milla
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Ricardo Villa-Bellosta
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio Piñero
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Felipe Navarro
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Egido
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- Department of Nephrology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
| | - José Tuñón
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Laboratory of Vascular Pathology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
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Savanelli MC, Scarano E, Muscogiuri G, Barrea L, Vuolo L, Rubino M, Savastano S, Colao A, Di Somma C. Cardiovascular risk in adult hypopituitaric patients with growth hormone deficiency: is there a role for vitamin D? Endocrine 2016; 52:111-9. [PMID: 26511949 DOI: 10.1007/s12020-015-0779-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/16/2015] [Indexed: 11/26/2022]
Abstract
Hypovitaminosis D represent an environmental risk factors for cardiovascular (CV) disease. To investigate the prevalence of hypovitaminosis D and the correlation between GH/IGF-I deficiency and hypovitaminosis D with CV risk in GH deficiency (GHD) patients. A link between these hormones has been shown. Forty-one hypopituitaric patients with GHD (22 males, age 18-84 years) and 41 controls were enrolled in the study. Anthropometric parameters, blood pressure, glucose and lipid profile, parathyroid hormone (PTH), 25(OH) vitamin D (vitamin D), metabolic syndrome (MS), GH peak after GHRH + ARG, IGF-I, and standard deviation score (SDS) of IGF-I (zIGF-I) were assessed. Vitamin D levels were lower in patients than in controls (21.3 ± 12.3 vs. 28.2 ± 9.4, p = 0.006). Deficiency was found in 51 % of patients versus 14.6 % of controls (p < 0.01), insufficiency in 26.8 versus 41.4 % (p = 0.269) and normal vitamin D levels in 21.9 versus 43.9 % (p = 0.060). The prevalence of dyslipidemia was 51.2 % in patients versus 12.1 % in controls (p < 0.001), type 2 diabetes mellitus (DM) was 7.3 versus 17 % (p = 0.292), hypertension was 44 versus 22 % (p = 0.060), and MS was 17 versus 14.6 % (p = 0.957). In patients, an association was found between the presence of hypovitaminosis D and the prevalence of dyslipidemia, hypertension and MS and between zIGF-I and the prevalence of hypertension. Hypovitaminosis D was the most powerful predictor of the prevalence of dyslipidemia and hypertension. GHD patients have an increased prevalence of hypovitaminosis D compared with controls. The presence of hypovitaminosis D was the most powerful predictor of the prevalence of dyslipidemia and hypertension in GHD patients, suggesting the involvement of both factors in the CV risk in these patients.
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Affiliation(s)
| | - Elisabetta Scarano
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | | | - Laura Vuolo
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | - Manila Rubino
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
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Wall CR, Stewart AW, Camargo CA, Scragg R, Mitchell EA, Ekeroma A, Crane J, Milne T, Rowden J, Horst R, Grant CC. Vitamin D activity of breast milk in women randomly assigned to vitamin D3 supplementation during pregnancy. Am J Clin Nutr 2016; 103:382-8. [PMID: 26702121 DOI: 10.3945/ajcn.115.114603] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/11/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human milk is typically low in vitamin D activity (VDA). Whether the vitamin D content of breast milk at birth can be increased by supplementing the mother during pregnancy has not been reported to the best of our knowledge. OBJECTIVE We examined the effect of vitamin D supplementation during pregnancy on breast-milk VDA in the first 2 mo of lactation. DESIGN Breast-milk samples were obtained from women who were enrolled in a randomized, double-blinded, placebo-controlled trial of vitamin D supplementation during pregnancy. Pregnant women were enrolled at 27 wk of gestation and randomly assigned to the following 3 groups: a placebo group, a group who received one dosage of daily oral vitamin D3 (1000 IU), or a group who received 2 dosages of daily oral vitamin D3 (2000 IU). Serum 25-hydroxyvitamin D [25(OH)D] was measured at enrollment, at 36 wk of gestation, and in cord blood at birth. Study participants who were breastfeeding were invited to provide breast-milk samples for VDA measurement [concentration of vitamin D2, vitamin D3, 25(OH)D2, and 25(OH)D3] at 2 wk and 2 mo postpartum. A linear mixed model was used to compare breast-milk VDA between the 3 study groups. RESULTS A total of 75 women provided breast-milk samples (44 women provided breast-milk samples at both 2 wk and 2 mo postpartum). The mean (95% CI) VDA at age 2 wk was 52 IU/L (12, 217 IU/L) in the placebo group, 51 IU/L (17, 151 IU/L) in the 1000-IU group, and 74 IU/L (25, 221 IU/L) in the 2000-IU group; and at age 2 mo, the mean (95% CI) VDA was 45 IU/L (16, 124 IU/L), 43 IU/L (18, 103 IU/L), and 58 IU/L (15, 224 IU/L), respectively. There was no significant interaction in VDA between the sample-collection time and treatment (P = 0.61), but there was a difference between lower- and higher-dosage treatment groups (P = 0.04). CONCLUSION Maternal vitamin D supplementation during pregnancy of 2000 IU/d (compared with 1000 IU/d and with a placebo) results in a higher VDA of breast milk ≥2 mo postpartum. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12610000483055.
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Affiliation(s)
| | | | - Carlos A Camargo
- Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Alec Ekeroma
- Obstetrics & Gynecology, University of Auckland, Auckland, New Zealand
| | - Julian Crane
- Medicine, University of Otago, Wellington, New Zealand
| | - Tania Milne
- Department of Pediatrics: Child & Youth Health, and
| | - Judy Rowden
- Department of Pediatrics: Child & Youth Health, and
| | | | - Cameron C Grant
- Department of Pediatrics: Child & Youth Health, and Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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57
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Lovell AL, Wall CR, Grant CC. Do maternal dietary vitamin D intake and sunlight exposure affect the vitamin D status of exclusively breastfed infants? Nutr Diet 2016. [DOI: 10.1111/1747-0080.12254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Amy Luisa Lovell
- Discipline of Nutrition; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Clare Rosemary Wall
- Discipline of Nutrition; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Cameron Charles Grant
- Department of Paediatrics: Child and Youth Health; Starship Children's Hospital, Auckland District Health Board; Auckland New Zealand
- Department of General Paediatrics; Starship Children's Hospital, Auckland District Health Board; Auckland New Zealand
- Centre for Longitudinal Research-He Ara ki Mua; University of Auckland; Auckland New Zealand
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58
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McDonnell SL, Baggerly LL, French CB, Heaney RP, Gorham ED, Holick MF, Scragg R, Garland CF. Incidence rate of type 2 diabetes is >50% lower in GrassrootsHealth cohort with median serum 25-hydroxyvitamin D of 41 ng/ml than in NHANES cohort with median of 22 ng/ml. J Steroid Biochem Mol Biol 2016; 155:239-44. [PMID: 26151742 DOI: 10.1016/j.jsbmb.2015.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 12/31/2022]
Abstract
Higher serum 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with lower risk of type 2 diabetes. This study compared incidence rates of type 2 diabetes among participants aged ≥20 years in two U.S. cohorts with markedly different median 25(OH)D concentrations. The median 25(OH)D concentration in the GrassrootsHealth (GRH) cohort was 41 ng/ml (N=4933) while in the 2005-6 National Health and Nutrition Examination Survey (NHANES) it was 22 ng/ml (N=4078) (P<0.0001). The adjusted annual incidence rate of type 2 diabetes was 3.7 per 1000 population (95% confidence interval=1.9, 6.6) in the GRH cohort, compared to 9.3 per 1000 population (95% confidence interval=6.7, 12.6) in NHANES. In the NHANES cohort, the lowest 25(OH)D tertiles (<17, 17-24 ng/ml) had higher odds of developing diabetes than the highest tertile (OR: 4.9, P=0.02 and 4.8, P=0.01 respectively), adjusting for covariates. Differences in demographics and methods may have limited comparability. Raising serum 25(OH)D may be a useful tool for reducing risk of diabetes in the population.
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Affiliation(s)
| | | | | | | | - E D Gorham
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - M F Holick
- Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - R Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - C F Garland
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
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Kim IM, Norris KC, Artaza JN. Vitamin D and Cardiac Differentiation. VITAMINS AND HORMONES 2015; 100:299-320. [PMID: 26827957 DOI: 10.1016/bs.vh.2015.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Calcitriol (1,25-dihydroxycholecalciferol or 1,25-D3) is the hormonally active metabolite of vitamin D. Experimental studies of vitamin D receptors and 1,25-D3 establish calcitriol to be a critical regulator of the structure and function of the heart. Clinical studies link vitamin D deficiency with cardiovascular disease (CVD). Emerging evidence demonstrates that calcitriol is highly involved in CVD-related signaling pathways, particularly the Wnt signaling pathway. Addition of 1,25-D3 to cardiomyocyte cells and examination of its effects on cardiomyocytes and mainly Wnt11 signaling allowed the specific characterization of the role of calcitriol in cardiac differentiation. 1,25-D3 is demonstrated to: (i) inhibit cell proliferation without promoting apoptosis; (ii) decrease expression of genes related to the regulation of the cell cycle; (iii) promote formation of cardiomyotubes; (iv) induce expression of casein kinase-1-α1, a negative regulator of the canonical Wnt signaling pathway; and (v) increase expression of noncanonical Wnt11, which has been recognized to induce cardiac differentiation during embryonic development and in adult cells. Thus, it appears that vitamin D promotes cardiac differentiation through negative modulation of the canonical Wnt signaling pathway and upregulation of noncanonical Wnt11 expression. Future work to elucidate the role(s) of vitamin D in cardiovascular disorders will hopefully lead to improvement and potentially prevention of CVD, including abnormal cardiac differentiation in settings such as postinfarction cardiac remodeling.
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Affiliation(s)
- Irene M Kim
- Department of Health & Life Sciences, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jorge N Artaza
- Department of Health & Life Sciences, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Berridge MJ. Vitamin D cell signalling in health and disease. Biochem Biophys Res Commun 2015; 460:53-71. [PMID: 25998734 DOI: 10.1016/j.bbrc.2015.01.008] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/05/2015] [Indexed: 12/13/2022]
Abstract
Vitamin D deficiency has been linked to many human diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), hypertension and cardiovascular disease. A Vitamin D phenotypic stability hypothesis, which is developed in this review, attempts to describe how this vital hormone acts to maintain healthy cellular functions. This role of Vitamin D as a guardian of phenotypic stability seems to depend on its ability to maintain the redox and Ca(2+) signalling systems. It is argued that its primary action is to maintain the expression of those signalling components responsible for stabilizing the low resting state of these two signalling pathways. This phenotypic stability role is facilitated through the ability of vitamin D to increase the expression of both Nrf2 and the anti-ageing protein Klotho, which are also major regulators of Ca(2+) and redox signalling. A decline in Vitamin D levels will lead to a decline in the stability of this regulatory signalling network and may account for why so many of the major diseases in man, which have been linked to vitamin D deficiency, are associated with a dysregulation in both ROS and Ca(2+) signalling.
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Differential profile in inflammatory and mineral metabolism biomarkers in patients with ischemic heart disease without classical coronary risk factors. J Cardiol 2015; 66:22-7. [DOI: 10.1016/j.jjcc.2014.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/28/2014] [Accepted: 11/19/2014] [Indexed: 02/01/2023]
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Roy A, Lakshmy R, Tarik M, Tandon N, Reddy KS, Prabhakaran D. Independent association of severe vitamin D deficiency as a risk of acute myocardial infarction in Indians. Indian Heart J 2015; 67:27-32. [PMID: 25820047 DOI: 10.1016/j.ihj.2015.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/02/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Association of vitamin D deficiency with coronary heart disease (CHD) has been widely reported. Emerging data has shown high prevalence of vitamin D deficiency among Indians. However, this association has not been studied in Indians. METHODS A case-control study with 120 consecutive cases of first incident acute myocardial infarction (MI) and 120 age and gender matched healthy controls was conducted at All India Institute of Medical Sciences, New Delhi. The standard clinical and biochemical risk factors for MI were assessed for both cases and controls. Serum 25 (OH) vitamin D assay was performed from stored samples for cases and controls using radioimmunoassay. RESULTS Vitamin D deficiency [25(OH) D < 30 ng/ml] was highly prevalent in cases and controls (98.3% and 95.8% respectively) with median levels lower in cases (6 ng/ml and 11.1 ng/ml respectively; p < 0.001). The cases were more likely to have diabetes, hypertension and consume tobacco and alcohol. They had higher waist hip ratio, total and LDL cholesterol. Multivariate logistic regression analysis revealed severe vitamin D deficiency [25(OH) vitamin D < 10 ng/ml] was associated with a risk of MI with an odds ratio of 4.5 (95% CI 2.2-9.2). CONCLUSIONS This study reveals high prevalence of vitamin D deficiency among cases of acute MI and controls from India, with levels of 25 (OH)D being significantly lower among cases. Despite rampant hypovitaminosis, severe vitamin D deficiency was associated with acute MI after adjusting for conventional risk factors. This association needs to be tested in larger studies in different regions of the country.
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Affiliation(s)
- Ambuj Roy
- Additional Professor, Dept. of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
| | - Ramakrishnan Lakshmy
- Dept. of Cardiac Biochemistry, Cardiothoracic Centre, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Mohamad Tarik
- Dept. of Cardiac Biochemistry, Cardiothoracic Centre, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Nikhil Tandon
- Dept. of Endocrinology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - K Srinath Reddy
- Dept. of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India; President, Public Health Foundation of India Delhi, NCR, Plot No. 47, Sector 44, Institutional Area Gurgaon, Haryana 122003, India; Executive Director, Centre for Chronic Disease Control (CCDC) Professor, Chronic Disease Epidemiology, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Haryana 122003, India
| | - Dorairaj Prabhakaran
- Dept. of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
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Markers of subclinical atherosclerosis in premenopausal women with vitamin D deficiency and effect of vitamin D replacement. Atherosclerosis 2014; 237:784-9. [PMID: 25463121 DOI: 10.1016/j.atherosclerosis.2014.10.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/05/2014] [Accepted: 10/17/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent studies have revealed a relationship between vitamin D deficiency and atherosclerosis. This study aims to investigate the impact of vitamin D deficiency and replacement on markers of subclinical atherosclerosis in young premenopausal women in whom vitamin D deficiency is prevalent. METHODS Thirty-one premenopausal vitamin D deficient women and 27 age and gender-matched control subjects were enrolled in this study. Markers of subclinical atherosclerosis including carotid intima-media thickness (cIMT), flow-mediated dilatation (FMD), endothelial progenitor cell (EPC) count and cytokine levels were determined at baseline. All measurements were repeated at 6-month follow-up in vitamin D-deficient subjects after vitamin D replacement. RESULTS Vitamin D deficient premenopausal women had lower FMD (9.9 ± 1.3 vs. 13.8 ± 1.7%, p < 0.001) and EPC counts at baseline. This population also had lower IL-10 and higher IL-17 levels. A 6-month vitamin D replacement therapy resulted in a significant increase in FMD (9.9 ± 1.3 vs. 11.4 ± 1.4%, p < 0.001) and EPC counts. Furthermore, cytokine profile shifted toward a more anti-inflammatory phenotype including elevated IL-10 and decreased IL-17 levels. cIMT was not different between patient and control groups and did not change following vitamin D replacement. Change in 25(OH)D and IL-17 levels were independent predictors of the change in FMD measurements following vitamin D replacement. CONCLUSION This study demonstrates that endothelial function is impaired in otherwise healthy vitamin D deficient young premenopausal women and improves with 6-month replacement therapy. Immune-modulatory effects of vitamin D may, at least partly, be responsible for its beneficial effects on vascular health.
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The association of serum vitamin D concentration with serious complications after noncardiac surgery. Anesth Analg 2014; 119:603-612. [PMID: 25121616 DOI: 10.1213/ane.0000000000000096] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamin D deficiency is a global health problem. Epidemiological studies demonstrate that vitamin D is both cardioprotective and neuroprotective. Vitamin D also plays a substantial role in innate and acquired immunity. Our goal was to evaluate the association of serum vitamin D concentration on serious postoperative complications and death in noncardiac surgical patients. METHODS We retrospectively analyzed the data of 3509 patients who had noncardiac surgery at the Cleveland Clinic Main Campus and had a serum vitamin D measurement. The relationship between serum vitamin D concentration and all-cause in-hospital mortality, in-hospital cardiovascular morbidity, and serious in-hospital infections was assessed as a common effect odds ratio (OR) by using a multivariate generalized estimating equation model with adjustment for demographic, medical history variables, and type and duration of surgery. RESULTS Higher vitamin D concentrations were associated with decreased odds of in-hospital mortality/morbidity (P = 0.003). There was a linear reduction of the corresponding common effect odds ratio (OR 0.93, 95% confidence interval, 0.88-0.97) for severe in-hospital outcomes for each 5 ng/mL increase in vitamin D concentration over the range from 4 to 44 ng/mL. In addition, we found that the odds versus patients with vitamin D <13 ng/mL (i.e., 1st quintile) were significantly lower in patients with vitamin D 13-20, 20-27, 27-36, and > 36 ng/mL (i.e., 2nd-5th quintiles); the corresponding estimated ORs were 0.65 (99% confidence interval, 0.43-0.98), 0.53 (0.35-0.80), 0.44 (0.28-0.70), and 0.49 (0.31-0.78), respectively. However, there was no statistically significant difference among individual quintiles >13 ng/mL. CONCLUSIONS Vitamin D concentrations were associated with a composite of in-hospital death, serious infections, and serious cardiovascular events in patients recovering from noncardiac surgery. While causality cannot be determined from our retrospective analysis, the association suggests that a large randomized trial of preoperative vitamin D supplementation and postoperative outcomes is warranted.
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Abu el Maaty MA, Gad MZ. Vitamin D deficiency and cardiovascular disease: potential mechanisms and novel perspectives. J Nutr Sci Vitaminol (Tokyo) 2014; 59:479-88. [PMID: 24477243 DOI: 10.3177/jnsv.59.479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Interest in contemporary vitamin D research has been sparked in recent years, stemming from the identification of vitamin D receptors in virtually all cells as well as the enzymatic machinery necessary to produce its active form. Both epidemiological and in-vitro studies have linked vitamin D deficiency to enigmatic diseases including cardiovascular disease; however, a clear mechanistic link remains missing. This review highlights conclusions of observational studies, in-vitro experiments and randomized-controlled trials that aimed to link deficiency of the sunshine vitamin to one of the leading causes of death in the world, cardiovascular disease. Furthermore, putative mechanisms viewed from a novel perspective are also discussed.
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Affiliation(s)
- Mohamed A Abu el Maaty
- Biochemistry Department, Faculty of Pharmacy and Biotechnology, German University in Cairo
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Robinson AB, Tangpricha V, Yow E, Gurion R, Schanberg LE, McComsey GA. Vitamin D status is a determinant of atorvastatin effect on carotid intima medial thickening progression rate in children with lupus: an Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) substudy. Lupus Sci Med 2014; 1:e000037. [PMID: 25396067 PMCID: PMC4225736 DOI: 10.1136/lupus-2014-000037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/31/2014] [Accepted: 08/13/2014] [Indexed: 12/17/2022]
Abstract
Objective Epidemiological associations suggest that vitamin D status may play a role in inflammation and progression of atherosclerosis. Using frozen serum, carotid intima medial thickness (CIMT) measurements and other existing data from the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) trial, we assessed interactions between serum 25-hydroxyvitamin D (25(OH)D), atorvastatin randomisation and CIMT progression rate. Methods Participants in the 3-year APPLE trial were randomised to placebo or atorvastatin and CIMT progression rate was measured. Baseline frozen serum was used to measure 25(OH)D concentrations. Mixed effect longitudinal models for CIMT progression at 3 years were used to evaluate interaction between vitamin D deficiency (serum 25(OH)D <20 ng/mL) at baseline and atorvastatin or placebo treatment, adjusting for key systemic lupus erythematosus disease variables and cardiovascular risk factors. Results 201/221 APPLE participants had available samples and were included in this analysis; 61/201 (30%) had vitamin D deficiency at baseline. In adjusted longitudinal modelling, there was significant interaction between baseline vitamin D deficiency and atorvastatin randomisation in 3-year progression of mean-max CIMT. In four out of six carotid segments, there was a greater decrease in mean-max CIMT progression rate in subjects who were treated with atorvastatin compared with placebo if they had baseline serum 25(OH)D levels ≥20 ng/mL. Conclusions Subjects with serum 25(OH)D ≥20 ng/mL had less mean-max CIMT progression following 3 years of atorvastatin treatment. Results from secondary analyses must be interpreted cautiously, but findings suggest that underlying vitamin D deficiency may be involved in response to atorvastatin in atherosclerosis prevention. Trial registration number NCT00065806.
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Affiliation(s)
- Angela Byun Robinson
- Department of Pediatrics , Rainbow Babies and Children's Hospital/Case Medical Center , Cleveland, Ohio , USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Eric Yow
- Duke Clinical Research Institute , Durham, North Carolina , USA
| | - Reut Gurion
- Department of Pediatrics , Rainbow Babies and Children's Hospital/Case Medical Center , Cleveland, Ohio , USA
| | - Laura E Schanberg
- Department of Pediatrics , Duke University Medical Center , Durham, North Carolina , USA
| | - Grace A McComsey
- Department of Medicine and Pediatrics , Case Medical Center , Cleveland, Ohio , USA
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67
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Alla S, Mason DF. Multiple sclerosis in New Zealand. J Clin Neurosci 2014; 21:1288-91. [DOI: 10.1016/j.jocn.2013.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022]
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The link between vitamin D metabolism and sleep medicine. Sleep Med Rev 2014; 18:311-9. [DOI: 10.1016/j.smrv.2013.07.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 01/08/2023]
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Güdücü N, Görmüş U, Kutay SS, Kavak ZN, Dünder I. 25-Hydroxyvitamin D levels are related to hyperinsulinemia in polycystic ovary syndrome. Gynecol Endocrinol 2014; 30:557-60. [PMID: 24819314 DOI: 10.3109/09513590.2014.910189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To determine 25-hydroxyvitamin D levels and the relationship between 25-hydroxyvitamin D and metabolic disturbances including insulin resistance in women with PCOS. MATERIALS AND METHODS We compared biochemical, hormonal parameters and 25-hydroxyvitamin D levels of 58 women with PCOS and 38 body mass index matched controls. RESULTS There was no difference in 25-hydroxyvitamin D levels of women with PCOS and the control group. Low 25-hydroxyvitamin D levels in women with PCOS were related to higher insulin levels (r = -0.271 and p = 0.042). More than 90% of the subjects had hypovitaminosis D. The negative relationship between 25-hydroxyvitamin D levels and body mass index did not reach statistical significance. CONCLUSION Low 25-hydroxyvitamin D levels were related to hyperinsulinemia in women with PCOS.
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Pirgon O, Cekmez F, Bilgin H, Eren E, Dundar B. Low 25-hydroxyvitamin D level is associated with insulin sensitivity in obese adolescents with non-alcoholic fatty liver disease. Obes Res Clin Pract 2014; 7:e275-83. [PMID: 24306155 DOI: 10.1016/j.orcp.2012.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/25/2012] [Accepted: 01/26/2012] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to investigate the relationships between 25-hydroxy-vitamin D (25(OH)D) and insulin resistance in obese adolescents with non-alcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS Eighty-seven obese adolescents (45 girls and 42 boys, mean age: 12.7 ± 1.3 years, mean body mass index standard deviation score (BMI-SDS): 2.1 ± 0.3) and 30 lean subjects (15 girls and 15 boys, mean age: 12.3 ± 1.45 years, mean BMI-SDS: 0.5 ± 0.7) were enrolled for the study. The obese subjects were divided into two subgroups based on the presence or absence of fatty liver with high transaminases (NAFLD group and non-NAFLD group). Fasting blood samples were assayed for 25(OH)D, transaminases, glucose, and insulin levels. Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR). RESULTS 25(OH)D measurements were decreased in both obese groups (NAFLD and non-NAFLD) in comparison with the lean group (29.5 ± 18.4 vs. 41.0 ± 17.9 vs. 48.1 ± 22.2 ng/mL). However; the NAFLD group had significantly lower measurements of 25(OH)D than the non-NAFLD group (p < 0.001) and lean group (p < 0.001). 25(OH)D was negatively correlated with HOMA-IR (r = 0.158, p = 0.01) and with alanine aminotransferase (r = 0.794, p = 0.03) in the NAFLD obese group. There was no significant associations between fasting insulin, BMI-SDS and 25(OH)D in obese groups. CONCLUSION We suggest that low 25(OH)D occurs commonly in obese adolescents with NAFLD and we demonstrated an association between insufficient vitamin D status and low insulin sensitivity in obese adolescents with NAFLD.
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Affiliation(s)
- Ozgur Pirgon
- Department of Pediatric Endocrinology and Diabetes, Konya Research Hospital, Konya, Turkey.
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Karur S, Veerappa V, Nanjappa MC. Study of vitamin D deficiency prevalence in acute myocardial infarction. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:57-59. [PMID: 29450171 PMCID: PMC5801269 DOI: 10.1016/j.ijchv.2014.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Deficiency of 25-hydroxy vitamin D [25(OH)D] is a treatable condition that has been associated with coronary artery disease and many of its risk factors. A practical time to assess for 25(OH)D deficiency, and to initiate treatment, is at the time of an acute myocardial infarction(AMI). The prevalence of 25(OH)D deficiency and the characteristics associated with it in patients with acute myocardial infarction are unknown. METHODS In this study 25(OH)D was assessed in 314 subjects enrolled in a Sri Jayadeva Institute of Cardiovascular Science and Research(SJICS&R). Patients enrolled from December 1, 2011 to February 28, 2012 had serum samples sent to a centralized laboratory for analysis using the ELECYS assay. Normal 25(OH)D levels are ≥ 30 ng/ml, and patients with levels < 30 and > 20 ng/ml were classified as insufficient and those with levels ≤ 20 ng/ml as deficient. Vitamin D and other baseline characteristics were analyzed with T-test and chi-squared test. RESULTS Of the 314 enrolled patents, 212 (67.5%) were 25(OH)D deficient and 50(16%) were insufficient, for a total of 83.5% of patients with abnormally low 25(OH)D levels. No significant heterogeneity was observed among age or gender sub groups but 25(OH)D deficiency was more commonly seen in those with lower socioeconomic status, lower activity levels, diabetes, hypercholesterolemia(LDL), hypertriglyceridemia and in smokers. CONCLUSION Vitamin D deficiency is present in most of the patients with acute myocardial infarction and it is associated with many of its risk factors in our study.
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Affiliation(s)
- Satish Karur
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Road, Jayanagar 9th Block, Bangalore, Karnataka 560069, India
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Challoumas D. Vitamin D supplementation and lipid profile: what does the best available evidence show? Atherosclerosis 2014; 235:130-9. [PMID: 24835432 DOI: 10.1016/j.atherosclerosis.2014.04.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/10/2014] [Accepted: 04/13/2014] [Indexed: 01/14/2023]
Abstract
Vitamin D supplements have increasingly been used for the treatment and prevention of osteoporosis. Historically, effects of the vitamin on the cardiovascular (CV) system have been proposed and demonstrated in the literature, including benefits on serum lipids. Although observational studies support an association between increased serum vitamin D levels and a favorable lipid profile, interventional studies have shown no effects. This review presents and analyzes all the related randomized controlled trials (RCTs) identified in the literature from 1987 to present. A systematic literature search was conducted via MEDLINE, Cochrane Library and EMBASE and, out of 19 relevant RCTs identified, only one reported benefits of vitamin D supplementation on lipid profile parameters, while the rest showed no effects or even adverse outcomes, which are highlighted by the only meta-analysis in the field. Attempts to explain the paradox of beneficial findings of observational studies versus discouraging results of interventional studies have been made and the most popular suggests that high serum vitamin D concentrations may not be the cause of good health but its outcome instead, as healthy people are more likely to stay outdoors longer and have better eating habits. For definitive answers to be given, large, well-designed RCTs need to be conducted that will take into account and adjust for dietary consumption as well as serum calcium and parathyroid hormone levels, both of which have been shown to be associated with the CV system. Until then, recommendations for vitamin D supplementation should not change.
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Affiliation(s)
- Dimitrios Challoumas
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff CF14 4XW, UK.
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Tuñón J, Cristóbal C, Tarín N, Aceña Á, González-Casaus ML, Huelmos A, Alonso J, Lorenzo Ó, González-Parra E, Mahíllo-Fernández I, Pello AM, Carda R, Farré J, Rodríguez-Artalejo F, López-Bescós L, Egido J. Coexistence of low vitamin D and high fibroblast growth factor-23 plasma levels predicts an adverse outcome in patients with coronary artery disease. PLoS One 2014; 9:e95402. [PMID: 24748388 PMCID: PMC3991663 DOI: 10.1371/journal.pone.0095402] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/26/2014] [Indexed: 11/18/2022] Open
Abstract
Objective Vitamin D and fibroblast growth factor-23 (FGF-23) are related with cardiovascular disorders. We have investigated the relationship of calcidiol (vitamin D metabolite) and FGF-23 plasma levels with the incidence of adverse outcomes in patients with coronary artery disease. Methods Prospective follow-up study of 704 outpatients, attending the departments of Cardiology of four hospitals in Spain, 6–12 months after an acute coronary event. Baseline calcidiol, FGF-23, parathormone, and phosphate plasma levels were assessed. The outcome was the development of acute ischemic events (any acute coronary syndrome, stroke, or transient ischemic attack), heart failure, or death. Cox regression adjusted for the main confounders was performed. Results Calcidiol levels showed a moderate-severe decrease in 57.3% of cases. Parathormone, FGF-23, and phosphate levels were increased in 30.0%, 11.5% and 0.9% of patients, respectively. Only 22.4% of patients had glomerular filtration rate<60 ml/min1.73 m2. After a mean follow-up was 2.15±0.99 years, 77 patients developed the outcome. Calcidiol (hazard ratio [HR] = 0.67; 95% confidence interval [CI] = 0.48–0.94; p = 0.021) and FGF-23 (HR = 1.13; 95% CI = 1.04–1.23; p = 0.005) plasma levels predicted independently the outcome. There was a significant interaction between calcidiol and FGF-23 levels (p = 0.025). When the population was divided according to FGF-23 levels, calcidiol still predicted the outcome independently in patients with FGF-23 levels higher than the median (HR = 0.50; 95% CI = 0.31–0.80; p = 0.003) but not in those with FGF-23 levels below this value (HR = 1.03; 95% CI = 0.62–1.71; p = 0.904). Conclusions Abnormalities in mineral metabolism are frequent in patients with stable coronary artery disease. In this population, low calcidiol plasma levels predict an adverse prognosis in the presence of high FGF-23 levels.
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Affiliation(s)
- José Tuñón
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- * E-mail:
| | - Carmen Cristóbal
- Department of Cardiology, Hospital de Fuenlabrada, Fuenlabrada, Spain
- Rey Juan Carlos University, Alcorcón, Spain
| | - Nieves Tarín
- Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Ana Huelmos
- Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Joaquín Alonso
- Department of Cardiology, Hospital de Fuenlabrada, Fuenlabrada, Spain
- Rey Juan Carlos University, Alcorcón, Spain
| | - Óscar Lorenzo
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | - Emilio González-Parra
- Autónoma University, Madrid, Spain
- Department of Nephrology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Ana María Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Jerónimo Farré
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, Madrid, Spain
| | | | - Jesús Egido
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- Department of Nephrology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
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Uberti F, Lattuada D, Morsanuto V, Nava U, Bolis G, Vacca G, Squarzanti DF, Cisari C, Molinari C. Vitamin D protects human endothelial cells from oxidative stress through the autophagic and survival pathways. J Clin Endocrinol Metab 2014; 99:1367-74. [PMID: 24285680 DOI: 10.1210/jc.2013-2103] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Recently, vitamin D (VitD) has been recognized as increasingly importance in many cellular functions of several tissues and organs other than bone. In particular, VitD showed important beneficial effects in the cardiovascular system. Although the relationship among VitD, endothelium, and cardiovascular disease is well established, little is known about the antioxidant effect of VitD. OBJECTIVE Our objective was to study the intracellular pathways activated by VitD in cultured human umbilical vein endothelial cells undergoing oxidative stress. DESIGN Nitric oxide production, cell viability, reactive oxygen species, the mitochondrial permeability transition pore, membrane potential, and caspase-3 activity were measured during oxidative stress induced by administration of 200 μM hydrogen peroxide for 20 minutes. Experiments were repeated in the presence of specific vitamin D receptor ligand ZK191784. RESULTS Pretreatment with VitD alone or in combination with ZK191784 is able to reduce the apoptosis-related gene expression, involving both intrinsic and extrinsic pathways. At the same time, it has been shown the activation of pro-autophagic beclin 1 and the phosphorylation of ERK1/2 and Akt, indicating a modulation between apoptosis and autophagy. Moreover, VitD alone or in combination with ZK191784 is able to prevent the loss of mitochondrial potential and the consequent cytochrome C release and caspase activation. CONCLUSIONS The present study shows that VitD may prevent endothelial cell death through modulation of the interplay between apoptosis and autophagy. This effect is obtained by inhibiting superoxide anion generation, maintaining mitochondria function and cell viability, activating survival kinases, and inducing NO production.
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Affiliation(s)
- F Uberti
- Department of Obstetrics and Gynecology (F.U., D.L., V.M., U.N.), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità (G.B.), Università degli Studi di Milano, 20122, Milan, Italy Dipartimento di Medicina Traslazionale (V.M., G.V., D.F.S., C.M.), Università degli Studi del Piemonte Orientale A. Avogadro, 28100 Novara, Italy; and Dipartimento di Scienze della Salute (C.C.), Università degli Studi del Piemonte Orientale A. Avogadro, 28100 Novara, Italy
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Arnson Y, Itzhaky D, Mosseri M, Barak V, Tzur B, Agmon-Levin N, Amital H. Vitamin D inflammatory cytokines and coronary events: a comprehensive review. Clin Rev Allergy Immunol 2014; 45:236-47. [PMID: 23314982 DOI: 10.1007/s12016-013-8356-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Myocardial infarction (MI) is the most common cause of cardiac injury in the Western world. Cardiac injury activates innate immune mechanisms initiating an inflammatory reaction. Inflammatory cytokines and vascular cell adhesion molecules (VCAM) promote adhesive interactions between leukocytes and endothelial cells, resulting in the transmigration of inflammatory cells into the site of injury. Low vitamin D levels are associated with higher prevalence of cardiovascular risk factors and a higher risk of MI. In this paper, we examine the effects of short-term vitamin D supplementation on inflammatory cytokine levels after an acute coronary syndrome. We recruited patients arriving to the hospital with an acute MI. All patients received optimal medical therapy and underwent a coronary catheterization. Half of the patients were randomly selected and treated with a daily supplement of vitamin D (4,000 IU) for 5 days. A short course of treatment with vitamin D effectively attenuated the increase in circulating levels of inflammatory cytokines after an acute coronary event. Control group patients had increased cytokine and cellular adhesion molecules serum concentrations after 5 days, while the vitamin D-treated group had an attenuated elevation or a reduction of these parameters. There were significant differences in VCAM-1 levels, C-reactive protein, and interleukin-6. There were trends toward significance in interleukin-8 levels. There were no significant differences in circulating levels of intercellular adhesion molecule 1, E-selectin, vascular endothelial growth factor, and tumor necrosis factor-α. These findings provide information on the anti-inflammatory effects of vitamin D on the vascular system and suggest mechanisms that mediate some of its cardioprotective properties. There is place for further studies involving prolonged vitamin D treatment in patients suffering from ischemic heart disease.
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Affiliation(s)
- Yoav Arnson
- Cardiology Division, Meir Medical Center, Kfar Saba, Israel
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Aypak C, Türedi O, Yüce A. The association of vitamin D status with cardiometabolic risk factors, obesity and puberty in children. Eur J Pediatr 2014; 173:367-73. [PMID: 24132388 DOI: 10.1007/s00431-013-2177-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/03/2013] [Indexed: 01/19/2023]
Abstract
UNLABELLED Low serum 25-hydroxyvitamin D3 (25(OH)D) levels have been associated with insulin resistance and cardiovascular diseases. The influences of gender, puberty and adiposity on vitamin D status and the relationship between 25(OH)D and cardiometabolic risk factors in obese and non-obese children were studied. A retrospective analysis was carried out on 168 Turkish children during late winter. Age, gender, puberty, body mass index (BMI), 25(OH)D levels and cardiometabolic risk factors including lipid profiles, high-sensitivity C-reactive protein and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated. The median age of the study population was 11 (4-16) years, and 102 children (60.7 %) were prepubertal. Overall, 98.2 % of patients had 25(OH)D levels lower than 20 ng/mL (median 10.0 (4.0-21.3) ng/mL). The 25(OH)D levels did not correlate with BMI. However, an inverse correlation was seen between serum 25(OH)D and HOMA-IR (rho = -0.656, p = 0.006) and insulin (rho = -0.715, p = 0.002) in pubertal obese subjects. Female gender and puberty were all negatively associated with 25(OH)D. CONCLUSION The association between vitamin D status and BMI is complex, and it does not seem to be altered by mild obesity. In addition, potential influence of puberty should be kept in mind while assessing the relationship between serum 25(OH)D and cardiometabolic risk factors.
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Affiliation(s)
- Cenk Aypak
- Department of Family Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, 06110, Ankara, Turkey,
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Walker MD, Cong E, Kepley A, Di Tullio MR, Rundek T, Homma S, Lee JA, Liu R, Young P, Zhang C, McMahon DJ, Silverberg SJ. Association between serum 25-hydroxyvitamin D level and subclinical cardiovascular disease in primary hyperparathyroidism. J Clin Endocrinol Metab 2014; 99:671-80. [PMID: 24285686 PMCID: PMC3913802 DOI: 10.1210/jc.2013-3523] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Vitamin D (25OHD) deficiency may be a modifiable cardiovascular (CV) risk factor. 25OHD insufficiency (20-29 ng/mL) and deficiency (<20 ng/mL) are common in primary hyperparathyroidism (PHPT), but their association with CV disease in PHPT has not been systematically investigated. OBJECTIVE This study evaluated whether low 25OHD is associated with subclinical CV disease in PHPT. DESIGN This is a cross-sectional analysis of PHPT patients with and without low 25OHD. SETTINGS AND PARTICIPANTS We studied 110 PHPT patients in a university hospital setting. OUTCOME MEASURES We measured carotid intima-media thickness; carotid plaque presence/thickness; carotid strain and stiffness; left ventricular mass index; cardiac systolic and diastolic function; and mitral annular calcification. RESULTS Low 25OHD levels (<30 ng/mL) were observed in 28%, but only 9% had 25OHD deficiency (<20 ng/mL). In the whole group, 25OHD levels negatively correlated with body mass index (r = -0.33, P = .0005), PTH (r = -0.30, P = .001), calcium (r = -0.29, P = .002), renal function, and PHPT duration. CV indices were normal except for carotid intima-media thickness, stiffness, and plaque thickness, which were increased, regardless of 25OHD status. Isovolumic relaxation time was the only CV measure associated with 25OHD (r = -0.26, P = .01). Those with 25OHD less than 20 ng/mL had more severe PHPT and a higher rate of nephrolithiasis. Those with 25OHD less than 30 ng/mL were younger, had higher body mass index, had lower serum phosphate, and were more likely to be male, nonwhite, and Hispanic. Other than lower tissue Doppler e' and higher isovolumic relaxation time within normal range in those with 25OHD less than 30 vs greater than 30 ng/mL, there were no differences in CV indices using either 25OHD threshold. CONCLUSIONS Patients with mild PHPT have subclinical carotid abnormalities, but low 25OHD is not associated with abnormal carotid or cardiac measures. To the extent that PTH levels differentiated those with 25OHD less than 20 but not 30 ng/mL, these data support a 25OHD threshold of 20 ng/mL as clinically relevant in PHPT.
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Affiliation(s)
- Marcella D Walker
- Departments of Medicine (M.D.W., E.C., A.K., M.R.D.T., S.H., R.L., P.Y., C.Z., D.J.M., S.J.S.) and Surgery (J.A.L.), Columbia University, College of Physicians and Surgeons, New York, New York 10032; and Department of Neurology (T.R.), Miller School of Medicine, University of Miami, Miami, Florida 33136
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78
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Lucas RM. Critically evaluating the evidence: risk versus benefit for sun exposure. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.2.5.515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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79
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Deficiency of 25-hydroxyvitamin d and dyslipidemia in Indian subjects. J Lipids 2013; 2013:623420. [PMID: 24455278 PMCID: PMC3880703 DOI: 10.1155/2013/623420] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/15/2013] [Accepted: 11/24/2013] [Indexed: 01/28/2023] Open
Abstract
Background. Vitamin D deficiency is widespread throughout the world. Several reports have incriminated vitamin D deficiency as the cause of rickets, osteomalacia, and other chronic diseases. Recent studies have suggested a possible link between deficiency of 25-hydroxyvitamin D and dyslipidemia. Aim. To investigate the association between 25-hydroxyvitamin D deficiency and dyslipidemia in Indian subjects. Methodology. We recruited 150 asymptomatic consecutive subjects from patients' attendees at the Departments of Neurology and Medicine in Yashoda Hospital, Hyderabad, India. Study period was from October 2011 to March 2012. All subjects underwent 25-hydroxyvitamin D assay by chemiluminescent microparticle immunoassay, fasting blood sugar and lipid profile, calcium, phosphorus, alkaline phosphatase, and C-reactive protein (CRP). Results. Out of 150 subjects, men were 82 (54.6%), and mean age was 49.4 (±15.6) years. Among risk factors, hypertension was noted in 63/150 (42%), 25-hydroxyvitamin D deficiency in 59/150 (39.3%), diabetes in 45/150 (30%), dyslipidemia in 60 (40%), smoking in 35/150 (23.3%), and alcoholism in 27/150 (18%). Deficiency of 25-hydroxyvitamin D was significantly associated with dyslipidemia (P = 0.0001), mean serum glucose (P = 0.0002) mean CRP (P = 0.04), and mean alkaline phosphatase (P = 0.01). Multivariate analysis showed that 25-hydroxyvitamin D deficiency was independently associated with dyslipidemia (odds ratio: 1.9; 95% CI : 1.1–3.5). Conclusions. We found that deficiency of 25-hydroxyvitamin D was independently associated with dyslipidemia in Indian subjects.
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80
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Baker A, Wood CL, Wood AM, Timms P, Allsopp AJ. Changes in vitamin D and matrix metalloproteinase-9 in submariners during a submerged patrol. Occup Environ Med 2013; 71:104-8. [DOI: 10.1136/oemed-2013-101793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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81
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Şeker T, Gür M, Kuloğlu O, Kalkan GY, Şahin DY, Türkoğlu C, Elbasan Z, Baykan AO, Gözübüyük G, Çaylı M. Serum 25-hydroxyvitamin D is associated with both arterial and ventricular stiffness in healthy subjects. J Cardiol 2013; 62:361-5. [DOI: 10.1016/j.jjcc.2013.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/14/2013] [Accepted: 06/05/2013] [Indexed: 02/07/2023]
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Topaloglu O, Arslan MS, Karakose M, Ucan B, Ginis Z, Cakir E, Akkaymak ET, Sahin M, Ozbek M, Cakal E, Delibasi T. Is There Any Association Between Thrombosis and Tissue Factor Pathway Inhibitor Levels in Patients With Vitamin D Deficiency? Clin Appl Thromb Hemost 2013; 21:428-33. [DOI: 10.1177/1076029613509477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: The aim of this study was to evaluate the relationship between vitamin D levels and hemostatic factors like tissue factor pathway inhibitor (TFPI). Methods: Patients who had 25-hydroxyvitamin D3 (25(OH)D3) levels measured were included. Coagulation and hemostatic parameters were evaluated. Patients were divided into 3 groups based on 25(OH)D3 levels as group 1 (25(OH)D3 < 10 ng/mL, n = 25), group 2 (25(OH)D3 = 10-19.9 ng/mL, n = 22), and group 3 (25(OH)D3 ≥ 20 ng/mL, n = 28). Results: A total of 75 patients with a mean age of 39 (range 18-57) years were included in the study. Prothrombin time was longer in group 3 than in group 2 ( P = .043). The TFPI levels were higher in group 3 than in the other groups ( P < .001). There was a strong positive correlation between 25(OH)D3 and TFPI levels ( r = .47, P < .001). Conclusion: Further studies are needed for evaluation of the role of TFPI in hemostasis and thrombotic process in patients with vitamin D deficiency.
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Affiliation(s)
- Oya Topaloglu
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Muyesser Sayki Arslan
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Melia Karakose
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Bekir Ucan
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Zeynep Ginis
- Department of Biochemistry, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Evrim Cakir
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Esra Tutal Akkaymak
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mustafa Sahin
- Department of Endocrinology and Metabolism, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Ozbek
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Tuncay Delibasi
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Ku YC, Liu ME, Ku CS, Liu TY, Lin SL. Relationship between vitamin D deficiency and cardiovascular disease. World J Cardiol 2013; 5:337-346. [PMID: 24109497 PMCID: PMC3783986 DOI: 10.4330/wjc.v5.i9.337] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/04/2013] [Indexed: 02/06/2023] Open
Abstract
Epidemiological studies have found that low 25-hydroxyvitamin D levels may be associated with coronary risk factors and adverse cardiovascular outcomes. Additionally, vitamin D deficiency causes an increase in parathyroid hormone, which increases insulin resistance and is associated with diabetes, hypertension, inflammation, and increased cardiovascular risk. In this review, we analyze the association between vitamin D supplementation and the reduction in cardiovascular disease. The role of vitamin D deficiency in cardiovascular morbidity and mortality is still controversial, and larger scale, randomized placebo controlled trials are needed to investigate whether oral vitamin D supplementation can reduce cardiovascular risk. Given the low cost, safety, and demonstrated benefit of higher 25-hydroxyvitamin D levels, vitamin D supplementation should become a public health priority for combating common and costly chronic cardiovascular diseases.
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84
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Beveridge LA, Witham MD. Vitamin D and the cardiovascular system. Osteoporos Int 2013; 24:2167-80. [PMID: 23468072 DOI: 10.1007/s00198-013-2281-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/21/2013] [Indexed: 12/31/2022]
Abstract
Vitamin D, a secosteroid hormone, affects multiple biological pathways via both genomic and nongenomic signalling. Several pathways have potential benefit to cardiovascular health, including effects on parathyroid hormone, the renin-angiotensin-aldosterone system, vascular endothelial growth factor and cytokine production, as well as direct effects on endothelial cell function and myocyte calcium influx. Observational data supports a link between low vitamin D metabolite levels and cardiovascular health. Cross-sectional data shows associations between low 25-hydroxyvitamin D levels and stroke, myocardial infarction, diabetes mellitus, hypertension, and heart failure. Longitudinal data also suggests a relationship with incident hypertension and new cardiovascular events. However, these associations are potentially confounded by reverse causality and by the effects that other cardiovascular risk factors have on vitamin D metabolite levels. Intervention studies to date suggest a modest antihypertensive effect of vitamin D, no effect on serum lipids, a small positive effect on insulin resistance and fasting glucose, and equivocal actions on arterial stiffness and endothelial function. Analysis of cardiovascular event data collected from osteoporosis trials does not currently show a clear signal for reduced cardiovascular events with vitamin D supplementation, but results may be confounded by the coadministration of calcium, and by the secondary nature of the analyses. Despite mechanistic and observational data that suggest a protective role for vitamin D in cardiovascular disease, intervention studies to date are less promising. Large trials using cardiovascular events as a primary outcome are needed before vitamin D can be recommended as a therapy for cardiovascular disease.
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Affiliation(s)
- L A Beveridge
- Ageing and Health, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
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Vitamin D Deficiency in Early Life and the Potential Programming of Cardiovascular Disease in Adulthood. J Cardiovasc Transl Res 2013; 6:588-603. [DOI: 10.1007/s12265-013-9475-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/14/2013] [Indexed: 01/17/2023]
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86
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Turan A, Grady M, You J, Mascha EJ, Keeyapaj W, Komatsu R, Bashour CA, Sessler DI, Saager L, Kurz A. Low vitamin D concentration is not associated with increased mortality and morbidity after cardiac surgery. PLoS One 2013; 8:e63831. [PMID: 23724006 PMCID: PMC3665712 DOI: 10.1371/journal.pone.0063831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/06/2013] [Indexed: 11/26/2022] Open
Abstract
Objective To determine the effect of vitamin D on postoperative outcomes in cardiac surgical patients. Design Retrospective study. Setting Single institution-teaching hospital. Participants Adult cardiac surgical patients with perioperative 25-hydroxyvitamin D measurements. Interventions None. We gathered information from the Cardiac Anesthesiology Registry that was obtained at the time of the patients’ visit/hospitalization. Measurements and Main Results We used data of 18,064 patients from the Cardiac Anesthesiology Registry; 426 patients with 25-hydroxyvitamin D measurements met our inclusion criteria. Association with Vitamin D concentration and composite of 11 cardiac morbidities was done by multivariate (i.e., multiple outcomes per subject) analysis. For other outcomes separate multivariable logistic regressions and adjusting for the potential confounders was used. The observed median vitamin D concentration was 19 [Q1-Q3∶12, 30] ng/mL. Vitamin D concentration was not associated with our primary composite of serious cardiac morbidities (odds ratio [OR], 0.96; 95% CI, 0.86–1.07). Vitamin D concentration was also not associated with any of the secondary outcomes: neurologic morbidity (P = 0.27), surgical (P = 0.26) or systemic infections (P = 0.58), 30-day mortality (P = 0.55), or length of initial intensive care unit (ICU) stay (P = 0.04). Conclusions Our analysis suggests that perioperative vitamin D concentration is not associated with clinically important outcomes, likely because the outcomes are overwhelmingly determined by other baseline and surgical factors.
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Affiliation(s)
- Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States of America.
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Vitamin D, calcium, and atherosclerotic risk: evidence from serum levels and supplementation studies. Curr Atheroscler Rep 2013; 15:293. [PMID: 23232985 DOI: 10.1007/s11883-012-0293-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vitamin D and calcium have traditionally been viewed in relation to bone health. However, recent research has suggested relations between these nutrients and cardiovascular disease (CVD). Specifically, evidence from both observational studies and clinical trials suggests that vitamin D may be related to lower risk of CVD. The picture for calcium is more complex. Dietary intake of calcium may be associated with lower CVD risk, while calcium supplementation may elevate CVD risk. In this review, we summarize evidence of these relations, and comment on the recent Institute of Medicine (IOM) recommendations regarding use of vitamin D and calcium supplements.
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Alele JD, Luttrell LM, Hollis BW, Luttrell DK, Hunt KJ. Relationship between vitamin D status and incidence of vascular events in the Veterans Affairs Diabetes Trial. Atherosclerosis 2013; 228:502-7. [PMID: 23608249 DOI: 10.1016/j.atherosclerosis.2013.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/06/2013] [Accepted: 03/26/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Few studies have examined the relationship between vitamin D levels and incident cardiovascular events in large well-characterized patient cohorts. Therefore, our objective was to determine if low vitamin D levels predicted vascular complications of diabetes. METHODS Prospective analysis of 936 veterans with type 2 diabetes (59.7 ± 8.4 years, 96.9% male) who participated in the Veteran Affairs Diabetes Trial (VADT) was conducted. 25(OH)-vitamin D was measured a median of two years after entry and participants were subsequently followed 3.7 years. Hazard ratios (HRs) were calculated for cardiovascular endpoints in relation to 25(OH)-vitamin D quartile. For microvascular endpoints, logistic regression was used to calculate odds ratios. RESULTS After adjusting for age, minority status, treatment arm and history of prior event, individuals in the lowest vitamin D quartile (i.e., 1-15.9 ng/ml) were at similar risk of MI [HR = 1.13 (95% CI: 0.53, 2.42)], CHD [HR = 0.87 (95% CI: 0.49, 1.55)], congestive heart failure [HR = 1.44 (95% CI: 0.67, 3.06)], and death from any cause [HR = 1.04 (95% CI: 0.53, 2.04)] as individuals in the highest vitamin D quartile (i.e., 29.9-77.2 ng/ml). Similarly, there were no differences in the odds associated with retinopathy or renal disease onset or progression in the lowest versus highest vitamin D quartile. CONCLUSIONS These data indicate that vitamin D status had no significant impact on the incidence of vascular events in a cohort of high-risk veterans with diabetes in which traditional risk factors were managed according to current treatment guidelines.
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Affiliation(s)
- Jimmy D Alele
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
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Abstract
Recent studies have provided evidence for an important role of vitamin D deficiency in the pathogenesis of cardiovascular disease (CVD) in the general population, and of an association with markers of inflammation. Vitamin D deficiency, defined by low serum levels of 25-hydroxyvitamin D, is especially prevalent in patients with chronic kidney disease (CKD). Chronic low-grade inflammation is a hallmark of CKD and has been disclosed as one important factor contributing to the progression of CKD and a high cardiovascular comorbidity. This review highlights clinical and experimental studies that could potentially explain a link between vitamin D and inflammation. Whether correction of vitamin D deficiency has beneficial effects on markers of inflammation and cardiovascular outcome should be investigated by controlled clinical trials.
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Affiliation(s)
- Uwe Querfeld
- Department of Paediatric Nephrology, Charité Children's Hospital, Augustenburger Platz 1, 13353, Berlin, Germany.
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Haque UJ, Bathon JM, Giles JT. Association of vitamin D with cardiometabolic risk factors in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013; 64:1497-504. [PMID: 22555877 DOI: 10.1002/acr.21715] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Individuals with rheumatoid arthritis (RA) are at a greater risk for cardiovascular disease (CVD). Vitamin D deficiency is a potential risk factor for CVD and metabolic syndrome. Since patients with RA have a high prevalence of vitamin D deficiency, we investigated the association of vitamin D levels with cardiometabolic risk factors in a cohort of RA patients with no prior history of CVD. METHODS Serum 25-hydroxyvitamin D (25[OH]D) levels were measured among RA patients enrolled in a cohort study of subclinical CVD. The cross-sectional associations of 25(OH)D levels with traditional CVD risk factors such as insulin resistance (IR; estimated using the homeostatic model assessment [HOMA]), adipokines, markers of systemic inflammation, and endothelial activation were explored, adjusting for pertinent sociodemographic, lifestyle, and RA characteristics. RESULTS Among 179 RA patients, 73 (41%) had a 25(OH)D level <30 ng/ml. Only 23 patients (13%) had a 25(OH)D level ≥45 ng/ml. After adjusting for demographics and body mass index (BMI), 25(OH)D remained significantly associated with high-density lipoprotein (HDL) cholesterol and inversely associated with HOMA-IR, fibrinogen, E-selectin, and soluble intercellular adhesion molecule 1 (sICAM-1). Significant associations with HDL cholesterol, E-selectin, and sICAM-1 were maintained after adjusting for the Disease Activity Score in 28 joints (DAS28) and autoantibody status. These associations were similar between the groups subdivided by sex, ethnicity, BMI, DAS28 level, and autoantibody status. CONCLUSION These data suggest that vitamin D deficiency is common in RA and may be independently associated with several cardiometabolic intermediates in this population.
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Affiliation(s)
- Uzma J Haque
- Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Tomson J, Emberson J, Hill M, Gordon A, Armitage J, Shipley M, Collins R, Clarke R. Vitamin D and risk of death from vascular and non-vascular causes in the Whitehall study and meta-analyses of 12 000 deaths. Eur Heart J 2012; 34:1365-74. [DOI: 10.1093/eurheartj/ehs426] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Vitamin D protects human endothelial cells from H₂O₂ oxidant injury through the Mek/Erk-Sirt1 axis activation. J Cardiovasc Transl Res 2012; 6:221-31. [PMID: 23247634 DOI: 10.1007/s12265-012-9436-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 12/05/2012] [Indexed: 12/30/2022]
Abstract
Endothelium homeostasis alterations govern the pathogenesis of cardiovascular diseases. Several studies show that vitamins anti-oxidant proprieties rescue the endothelial functions adversely affected by oxidative stress in several diseases. We investigated the vitamin D anti-oxidant potential in human endothelial cells exposed to H2O2 oxidative stress. Vitamin D protected endothelial cells against H2O2 oxidative stress counteracting the superoxide anion generation, the apoptosis and blocking the extrinsic caspase cascade by positively controlling phospho-active ERKs level. MEKs/ERKs inhibitor U0126 reverted the vitamin D anti-oxidant effects. Characterizing the vitamin D downstream effector, we found that vitamin D up-regulated SirT-1 and reverted the SirT-1 down-regulation induced by H2O2. ERKs activation by vitamin D strictly correlated with SirT-1 protein accumulation since both MEKs/ERKs inhibition and ERK1/2 silencing decreased SIRT-1. SirT-1 inhibition by Sirtinol reverted the vitamin D anti-oxidant effects. Thus, vitamin D significantly reduced the endothelial malfunction and damage caused by oxidative stress, through the activation of MEKs/ERKs/SirT-1 axis.
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Wang L, Song Y, Manson JE, Pilz S, März W, Michaëlsson K, Lundqvist A, Jassal SK, Barrett-Connor E, Zhang C, Eaton CB, May HT, Anderson JL, Sesso HD. Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes 2012; 5:819-29. [PMID: 23149428 DOI: 10.1161/circoutcomes.112.967604] [Citation(s) in RCA: 448] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamin D status has been linked to the risk of cardiovascular disease (CVD). However, the optimal 25-hydroxy-vitamin D (25[OH]-vitamin D) levels for potential cardiovascular health benefits remain unclear. METHODS AND RESULTS We searched MEDLINE and EMBASE from 1966 through February 2012 for prospective studies that assessed the association of 25(OH)-vitamin D concentrations with CVD risk. A total of 24 articles met our inclusion criteria, from which 19 independent studies with 6123 CVD cases in 65 994 participants were included for a meta-analysis. In a comparison of the lowest with the highest 25(OH)-vitamin D categories, the pooled relative risk was 1.52 (95% confidence interval, 1.30-1.77) for total CVD, 1.42 (95% confidence interval, 1.19-1.71) for CVD mortality, 1.38 (95% confidence interval, 1.21-1.57) for coronary heart disease, and 1.64 (95% confidence interval, 1.27-2.10) for stroke. These associations remained strong and significant when analyses were limited to studies that excluded participants with baseline CVD and were better controlled for season and confounding. We used a fractional polynomial spline regression analysis to assess the linearity of dose-response association between continuous 25(OH)-vitamin D and CVD risk. The CVD risk increased monotonically across decreasing 25(OH)-vitamin D below ≈60 nmol/L, with a relative risk of 1.03 (95% confidence interval, 1.00-1.06) per 25-nmol/L decrement in 25(OH)-vitamin D. CONCLUSIONS This meta-analysis demonstrated a generally linear, inverse association between circulating 25(OH)-vitamin D ranging from 20 to 60 nmol/L and risk of CVD. Further research is needed to clarify the association of 25(OH)-vitamin D higher than 60 nmol/L with CVD risk and assess causality of the observed associations.
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Affiliation(s)
- Lu Wang
- Brigham and Women’s Hospital, Boston, MA 02215, USA.
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95
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Glade MJ. Vitamin D: health panacea or false prophet? Nutrition 2012; 29:37-41. [PMID: 23085014 DOI: 10.1016/j.nut.2012.05.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 12/23/2022]
Abstract
Vitamin D deficiency, diagnosed when the serum 25-hydroxyvitamin D (25-OHD(3)) concentration is less than 20 ng/mL, has joined vitamin A deficiency as two of the most common nutrition-responsive medical conditions worldwide. There have been more scientific articles published about vitamin D in the 21st century than about any other vitamin, reflecting the massive expansion of the field of vitamin D research. Adequate vitamin D status has been linked to decreased risks of developing specific cancers, including cancers of the esophagus, stomach, colon, rectum, gallbladder, pancreas, lung, breast, uterus, ovary, prostate, urinary bladder, kidney, skin, thyroid, and hematopoietic system (e.g., Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma); bacterial infections; rheumatoid arthritis; Crohn's disease; periodontal disease; multiple sclerosis; asthma; type 2 diabetes; cardiovascular disease; stroke; peripheral artery disease; hypertension; chronic kidney disease; muscle weakness; cognitive impairment; Alzheimer's disease; clinical depression; and premature death. On the other hand, inadequate vitamin D status during human pregnancy may be associated with increased risk for the development of type 1 diabetes in the offspring. However, this point of view may be excessively optimistic. There also is evidence that despite the current heavy reliance on serum 25-OHD(3) concentration for the diagnosis of an individual's vitamin D status, local tissue vitamin D intoxication may be present in individuals with much lower serum 25-OHD(3) concentrations than are currently appreciated. Only rarely are the symptoms of local tissue vitamin D intoxication associated with vitamin D status or intake. An individual's serum 25-OHD(3) concentration may appear to be "low" for reasons totally independent of sunlight exposure or vitamin D intake. Serum 25-OHD(3) concentration is only poorly responsive to increases in vitamin D intake, and the prolonged routine consumption of thousands of international units of vitamin D may interfere with the regulation of phosphate homeostasis by fibroblast growth factor-23 (FGF23) and the Klotho gene product, with consequences that are detrimental to human health. In light of these counterbalancing observations, curbing excessive enthusiasm for universally increasing vitamin D intake recommendations may be in order.
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96
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Abstract
Vitamin D deficiency is common in women with polycystic ovary syndrome (PCOS), with the 67-85% of women with PCOS having serum concentrations of 25-hydroxy vitamin D (25OHD) <20 ng/ml. Vitamin D deficiency may exacerbate symptoms of PCOS, with observational studies showing lower 25OHD levels were associated with insulin resistance, ovulatory and menstrual irregularities, lower pregnancy success, hirsutism, hyperandrogenism, obesity and elevated cardiovascular disease risk factors. There is some, but limited, evidence for beneficial effects of vitamin D supplementation on menstrual dysfunction and insulin resistance in women with PCOS. Vitamin D deficiency may play a role in exacerbating PCOS, and there may be a place for vitamin D supplementation in the management of this syndrome, but current evidence is limited and additional randomized controlled trials are required to confirm the potential benefits of vitamin D supplementation in this population.
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Affiliation(s)
- Rebecca L Thomson
- Nutritional Physiology Research Centre, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
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97
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Whayne TF. Vitamin d: popular cardiovascular supplement but benefit must be evaluated. Int J Angiol 2012; 20:63-72. [PMID: 22654467 DOI: 10.1055/s-0031-1279679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Vitamin D deficiency is prevalent in the United States. Understanding any relationship between this deficiency and cardiovascular disease is essential. Vitamin D, as used, refers to both D(2) and D(3); both are present in over-the-counter supplements, whereas D(2) is the prescription product in the United States. In the liver, both D(2) and D(3) are converted to 25-hydroxyvitamin D, the major circulating metabolite that is measured to assess activity. The actual active form at a cellular level is 1,25-dihydroxyvitamin D; however, it does not correlate well with overall activity. Estimated vitamin D deficiency is, at times, more than 50%. Despite absence of placebo-controlled randomized trials, much information associates vitamin D deficiency with cardiovascular risk and supports benefit from vitamin D supplementation. There are also reports that explain how this benefit from vitamin D may occur. Vitamin D appears to cause only minimal changes in low- and high-density lipoprotein levels. Therefore, any cardiovascular benefit that may exist from vitamin D probably has an explanation other than an effect on levels of these lipoproteins. There is more association of vitamin D deficiency with metabolic syndrome components such as an increase in blood pressure, elevated plasma triglycerides, and impaired insulin metabolism. Possible documentation of cardiovascular benefit from vitamin D includes some evidence for endothelial stabilization and decreased inflammation in arteries. If the clinician decides that recommendation of vitamin D supplementation is warranted, it is reassuring that toxicity is rare. Furthermore, this toxicity involves doses exceeding those of most clinical trials and mainly has involved hypercalcemia. Vitamin D supplementation is easy and can be taken as a dose of 2000 IU daily on an indefinite basis. In 1997, the Food and Nutrition Board of the U.S. Institute of Medicine considered this the safe tolerable upper limit, but this is not based on current evidence. Some practitioners, especially endocrinologists, recommend vitamin D at a dose of 50,000 IU per week for 8 weeks, repeated if necessary to achieve a normal level of vitamin D. It appears appropriate to assess low vitamin D as a possible cardiovascular risk factor, but potential benefit of supplementation must be weighed against the current absence of definitive outcomes studies.
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Affiliation(s)
- Thomas F Whayne
- Professor of Medicine (Cardiology), Gill Heart Institute, University of Kentucky, Lexington, KY
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98
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Ma MK, Mok MM, Yung S, Tang CS, Chan TM. High Prevalence of Vitamin D Insufficiency in Southern Chinese Renal Transplant Recipients. Ren Fail 2012; 34:980-4. [DOI: 10.3109/0886022x.2012.706878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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99
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Szulc P. Association between cardiovascular diseases and osteoporosis-reappraisal. BONEKEY REPORTS 2012; 1:144. [PMID: 23951522 DOI: 10.1038/bonekey.2012.144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/01/2012] [Indexed: 12/31/2022]
Abstract
Positive association between cardiovascular diseases and osteoporosis is important because it concerns two major public health problems. Men and women with cardiovascular diseases (including severe abdominal aortic calcification (AAC) and peripheral arterial disease) tend to have lower areal and volumetric bone mineral density (BMD) as well as faster bone loss, although findings vary according to skeletal site. On one hand, severe forms of cardiovascular diseases (heart failure, myocardial infarction, hypertension, severe AAC) are associated with higher risk of osteoporotic fracture, especially hip fracture. This link was found in the studies based on healthcare databases and the cohort studies. On the other hand, low BMD, history of fragility fracture, vitamin D deficit and increased bone resorption are associated with higher risk of major cardiovascular events (myocardial infraction, stroke, cardiovascular mortality). Moreover, osteocalcin secreted by osteoblasts may be involved in the regulation of energetic and cardiovascular metabolism. The association between both pathologies depends partially on the shared risk factors, and also on the mechanisms that are involved in the regulation of bone and cardiovascular metabolism. Interpretation of the data should take into account methodological limitations: representativeness of the cohorts, quality of the registers and the information obtained from questionnaires, severity of diseases, number of events (statistical power) and their temporal closeness, availability of the information on potential confounders. It seems that patients with severe form of osteoporosis would benefit from assessment of the cardiovascular status and vice versa. However, official guidelines for the clinical practice are still lacking.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, Université de Lyon, Hôpital Edouard Herriot , Lyon, France
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100
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Glade MJ. A 21st century evaluation of the safety of oral vitamin D. Nutrition 2012; 28:344-56. [PMID: 22414585 DOI: 10.1016/j.nut.2011.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 11/08/2011] [Accepted: 11/09/2011] [Indexed: 12/14/2022]
Abstract
The safety of daily consumption of vitamin D was examined. A detailed literature search was conducted using the search term vitamin D; primary and secondary sources of original data and meta-analyses and systematic reviews were evaluated and summarized. A large body of scientific evidence demonstrates that long-term daily intakes of 600 to 800 IU of vitamin D are insufficient to achieve and sustain vitamin D adequacy (serum 25-hydroxyergocalciferol + 25-hydroxycholecalciferol concentration >75 nmol/L). Maximization of the physiologic benefits of vitamin D to the musculoskeletal system, the central and peripheral nervous systems, the heart and central and peripheral cardiovascular systems, the respiratory system, the skin, the eyes, dentition, glucoregulation, immunoregulation, and disease resistance requires daily vitamin D intakes of at least 1500 IU. Because long-term daily intakes up to and including 10 000 IU of vitamin D do not produce signs or symptoms of vitamin D toxicity and are safe for the entire general population of otherwise healthy adults, even daily vitamin D intakes of 2000 IU allow for the often-cited and excessively conservative five-fold safety factor. In conclusion, long-term daily intakes of up to and including 10 000 IU of vitamin D maximize physiologic benefits and are safe.
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