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Rasouli MA, Darvishzadehdaledari S, Alizadeh Z, Moradi G, Gholami F, Mahmoudian A. Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 134000 Individuals in 29 Randomized Clinical Trials and 157000 Individuals in 30 Prospective Cohort Studies: An Updated Systematic Review and Meta-analysis. J Res Health Sci 2023; 23:e00594. [PMID: 38315909 PMCID: PMC10843321 DOI: 10.34172/jrhs.2023.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/09/2023] [Accepted: 11/02/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND According to the findings from observational studies and clinical trials assessing the effect of vitamin D supplements on cardiovascular diseases (CVDs), there are still contradictory results. This systematic review aimed to assess the effect of vitamin D supplements on CVDs considering cohort studies and clinical trials. Study Design: A systematic review. METHODS MEDLINE/PubMed, Science Direct, Embase, and Cochrane Library databases were reviewed by two reviewers independently until 2022. The study effect is risk ratio (RR) and 95% confidence interval (CI) according to Mantel Haenszel's random-effects model. Then, Stata version 14 was used for statistical analysis. RESULTS In clinical trial studies, the incidence of CVDs among the vitamin D-consuming group was not significantly different from that in the placebo group (RR: 0.99, 95% CI: 0.95-1.03; P=0.77; I 2=0%). CVD mortality was also not significantly different between the two groups (RR: 0.97, 95% CI: 0.90-1.05; P=0.72; I2=0%). In cohort studies, circulating 25 (OH) D increased the risk of CVD incidence by 31% (RR: 1.31, 95% CI: 1.19-1.45) and CVD mortality by 37% (RR: 1.37, 95% CI: 1.17-1.61). CONCLUSION According to current evidence from clinical trials, vitamin D supplementation should not be recommended for CVD prevention. However, there is a direct association between vitamin D deficiency and the incidence of CVDs as well as its mortality. According to the results of clinical trial studies carrying higher levels of scientific evidence, it can be concluded that vitamin D supplementation does not exert a significant effect on the incidence, mortality, and reduction of CVDs.
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Affiliation(s)
- Mohammad Aziz Rasouli
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Zeynab Alizadeh
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fatemeh Gholami
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ako Mahmoudian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Luo W, Xu D, Zhang J, Zhou Y, Yang Q, Lv Q, Qu Z. Low serum 25-hydroxyvitamin D levels are associated with increased cardiovascular morbidity and mortality. Postgrad Med 2023; 135:93-101. [PMID: 36576147 DOI: 10.1080/00325481.2022.2161250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is controversy about the association between vitamin D and cardiovascular disease (CVD). This article aims to explore the association of serum 25-hydroxyvitaminD (25 OHD) with the risk of CVD. METHODS PubMed, EMBASE, Web of Science database, OVID, and Cochrane Library databases (last updated in August 2022) were systematically searched. The relationship between 25OHD and the risk of CVD was assessed by using the 95% confidence intervals (CI) and hazard ratio (HR). The effect model was selected by the size of heterogeneity. RESULTS The meta-analysis included 40 cohort studies that contained 652352 samples. The pooled results showed that a decreased level of 25OHD was associated with an increased relative risk of total CVD events (HR = 1.35, 95% CI: 1.26-1.43). Furthermore, the results also showed that a decreased circulating 25OHD level was associated with an increased mortality of CVD (HR = 1.43, 95% CI: 1.30-1.57) and incidence of CVD (HR = 1.26, 95% CI: 1.16-1.36), especially an increased risk of heart failure (HF) (HR = 1.38, 95% CI: 1.2-1.6), myocardial infarction (MI) (HR = 1.28, 95% CI: 1.13-1.44) and coronary heart disease (CHD) (HR = 1.28, 95% CI: 1.1-1.49). CONCLUSIONS The current meta-analysis shows that reduced serum 25OHD concentrations is not only associated with increased total cardiovascular events and cardiovascular mortality, but also with increased risk of HF, MI, and CHD. LIMITATIONS The underlying mechanism still needs to be explored further, and well-designed RCTs are needed to confirm the role of vitamin D in the occurrence and development of CVD.
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Affiliation(s)
- Wei Luo
- Department of Endocrinology, People's Hospital of Leshan, Leshan, China
| | - Dan Xu
- Department of Endocrinology, People's Hospital of Leshan, Leshan, China
| | - Jin Zhang
- Department of Endocrinology, People's Hospital of Leshan, Leshan, China
| | - Yao Zhou
- Department of Endocrinology, People's Hospital of Leshan, Leshan, China
| | - Qin Yang
- Department of Endocrinology, People's Hospital of Leshan, Leshan, China
| | - Qiuju Lv
- Department of Endocrinology, People's Hospital of Leshan, Leshan, China
| | - Zhen Qu
- Department of Endocrinology, People's Hospital of Leshan, Leshan, China
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Nanri A, Mizoue T, Goto A, Noda M, Sawada N, Tsugane S. Vitamin D intake and all-cause and cause-specific mortality in Japanese men and women: the Japan Public Health Center-based prospective study. Eur J Epidemiol 2023; 38:291-300. [PMID: 36719520 PMCID: PMC9887248 DOI: 10.1007/s10654-023-00968-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023]
Abstract
While higher circulating 25-hydroxyvitamin D concentrations have been reported to be associated with decreased risk of all-cause mortality, evidence on dietary vitamin D intake is limited and inconsistent. We investigated whether vitamin D intake is associated with all-cause and cause-specific mortality among Japanese adults. Participants were 42,992 men and 50,693 women who responded to the second survey of the Japan Public Health Center-based Prospective Study (1995-1998) and who were followed up for mortality through 2018. Dietary intake was ascertained using a validated food frequency questionnaire. Hazard ratios of deaths from the second survey to December 2018 were estimated using Cox proportional hazard regression analysis. During follow-up, we identified 22,630 deaths. Overall, the third and fourth quintiles, but not the highest quintile, of vitamin D intake were each associated with a significantly lower risk of all-cause mortality. In subgroups characterized by low sunlight exposure, risk of all-cause mortality decreased linearly with increasing vitamin D intake. The multivariable-adjusted hazard ratios (95% confidence intervals) of all-cause mortality for the highest versus lowest quintile of vitamin D intake were 0.87 (0.79-0.95) in women and 0.88 (0.79-0.97) in residents of higher latitude areas. Lower risk was also observed for all-cause mortality in participants with hypertension and for heart disease mortality in those with higher calcium intake. Higher vitamin D intake was associated with decreased risk of ischemic stroke and pneumonia mortality. Higher dietary vitamin D was associated with a lower risk of mortality among individuals with low sunlight exposure or hypertension. Individuals with potentially low vitamin D may benefit from increasing dietary vitamin D intake for the prevention of premature death.
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Affiliation(s)
- Akiko Nanri
- Department of Food and Health Sciences, International College of Arts and Sciences, Fukuoka Women's University, Fukuoka, Japan.
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Ichikawa, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
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Vitamin D and the Kidney: Two Players, One Console. Int J Mol Sci 2022; 23:ijms23169135. [PMID: 36012412 PMCID: PMC9409427 DOI: 10.3390/ijms23169135] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 01/08/2023] Open
Abstract
Vitamin D belongs to the group of liposoluble steroids mainly involved in bone metabolism by modulating calcium and phosphorus absorption or reabsorption at various levels, as well as parathyroid hormone production. Recent evidence has shown the extra-bone effects of vitamin D, including glucose homeostasis, cardiovascular protection, and anti-inflammatory and antiproliferative effects. This narrative review provides an overall view of vitamin D’s role in different settings, with a special focus on chronic kidney disease and kidney transplant.
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Jani R, Mhaskar K, Tsiampalis T, Kassaw NA, González MÁM, Panagiotakos DB. Circulating 25-hydroxy-vitamin D and the risk of cardiovascular diseases. Systematic review and meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis 2021; 31:3282-3304. [PMID: 34656382 DOI: 10.1016/j.numecd.2021.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022]
Abstract
AIMS Circulating vitamin D is linked with the risk of cardiovascular disease (CVD). A meta-analysis has yet to explicitly explore correlation between vitamin D and the risk of CVD incidence and recurrent CVD. This meta-analysis examines the association between 25-hydroxy-vitamin D (25(OH)D) and the risk of CVD incidence (fatal, non-fatal, fatal and non-fatal combined events) and the risk of recurrent CVD (fatal, recurrent, and fatal and recurrent combined events). PROSPERO registration-CRD42021251483. DATA SYNTHESIS A total of 79 studies (46 713 CVD cases in 1 397 831 participants) were included in the meta-analysis, of which 61 studies examined the risk of CVD incidence events, and 18 studies examined risk of recurrent CVD events. The risk of CVD incidence events (RR = 1.34, 95% CI: 1.26-1.43, p < 0.001) and recurrent CVD events (RR = 1.86, 95% CI: 1.46-2.36, p < 0.001) was higher in the lowest than the highest category of circulating 25(OH)D. Dose-response analysis reported a linear association for every 10 ng/ml increment of 25(OH)D and non-fatal CVD incidence events (RR = 0.94; 95% CI = 0.89-0.98, p = 0.005), lower fatal recurrent CVD events (RR = 0.45; 95% CI = 0.32-0.62, p < 0.001) and lower combined recurrent CVD events (RR = 0.80; 95% CI = 0.65-0.97, p = 0.023). A non-linear association was observed between higher 25(OH)D and lower fatal CVD incidence events (P-nonlinear<0.001), lower combined CVD incidence events (P-nonlinear = 0.001), and lower non-fatal recurrent CVD events (P-nonlinear = 0.044). CONCLUSIONS The lowest category of circulating 25(OH)D was associated with a higher risk of CVD incidence events and recurrent CVD events.
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Affiliation(s)
- Rati Jani
- Faculty of Health, Department of Nutrition and Dietetics, University of Canberra, Australia.
| | | | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
| | - Nigussie A Kassaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia.
| | | | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
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Ismail HM, Algrafi AS, Amoudi O, Ahmed S, Al-Thagfan SS, Shora H, Aljohani M, Almutairi M, Alharbi F, Alhejaili A, Alamri M, Muhawish A, Abdallah A. Vitamin D and Its Metabolites Deficiency in Acute Coronary Syndrome Patients Undergoing Coronary Angiography: A Case-Control Study. Vasc Health Risk Manag 2021; 17:471-480. [PMID: 34408425 PMCID: PMC8364363 DOI: 10.2147/vhrm.s312376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022] Open
Abstract
Background Vitamin D deficiency is considered an emerging health problem that affects at least one billion patients worldwide. Calcitriol 1,25(OH)2D3 has several systemic effects, including anti-inflammatory, anti-thrombotic and anti-atherosclerotic impacts that explain its cardioprotective effects. The precise association between vitamin D and its metabolites and the value of supplements in acute coronary syndrome (ACS) is still controversial. This study aims to search the association between vitamin D2, D3, and metabolites and ACS in patients undergoing coronary angiography. Materials and Methods This was a case–control study on 73 consecutive adult patients with ACS undergoing coronary angiography compared to 50 controls without coronary artery disease and matched for age and sex from June 2019 till July 2019. Echocardiography and coronary angiography were done for all cases. Plasma vitamin D and its metabolites were measured at admission for all participants along with chemistry profiles. Results Vitamin D and its metabolites were statistically significantly lower in ACS patients than the controls. Multivariate regression analysis revealed that low levels of 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) significantly predicted ACS occurrence; the other significant predictors were high systolic blood pressure (BP), high total cholesterol, and low high-density lipoprotein-cholesterol. Interestingly, vitamin D2 and D3 did not significantly predict ACS (p>0.05). We did not find a statistically significant association between the number of affected coronary vessels and vitamin D metabolites. Moreover, there was no statistically significant correlation between vitamin D and its metabolites and left ventricular ejection fraction measured by echocardiography. Conclusion There was a strong association between vitamin D and all its metabolites with ACS. Significantly, low 25(OH)D and 1,25(OH)2D predicted ACS, but vitamin D2 and D3 did not. Large randomized controlled trials are needed to verify the beneficial values of vitamin D supplementation in ACS patients.
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Affiliation(s)
- Hussein M Ismail
- Department of cardiology, College of Medicine, Suez Canal University, Ismailia, Egypt.,Department of medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Abeer S Algrafi
- Department of medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Osama Amoudi
- Madinah Cardiac Center, Adult cardiology, Al-Madinah Al-Munawara, Saudi Arabia
| | - Sameh Ahmed
- Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Sultan S Al-Thagfan
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Hassan Shora
- Department of molecular biology/biochemistry, Port Said University, Port Said, Egypt
| | - Mohammed Aljohani
- Medical intern, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | | | - Fahad Alharbi
- Medical intern, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | | | - Majed Alamri
- Medical intern, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Abdullah Muhawish
- Medical intern, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Ayat Abdallah
- Epidemiology and Preventive Medicine Department, National Liver Institute, Shebin El-Kom, Egypt.,Department of Family and Community Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
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Simsek B, Selte A, Egeli BH, Çakatay U. Effects of vitamin supplements on clinical cardiovascular outcomes: Time to move on! - A comprehensive review. Clin Nutr ESPEN 2021; 42:1-14. [PMID: 33745562 PMCID: PMC9587338 DOI: 10.1016/j.clnesp.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/30/2021] [Accepted: 02/05/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Vitamin supplementations have increasingly been advertised on media and reported to be widely used by the general public to improve cardiovascular health. Due to the COVID-19 pandemic, people have become more interested in ways to improve and maintain their health. Increased awareness of people on healthy lifestyle is translating into inquisition regarding dietary supplements. AIM First, focus on the most commonly used vitamin supplements and comprehensively review the evidence for and against recommending them to patients to improve and/or maintain cardiovascular health. Second, illustrate how the interest in studies shifted over time from Vitamin A, E, C, and B to Vitamin D and observational studies led to randomized controlled trials. METHODS A thorough PubMed search with the phrase: "Vitamin supplements and cardiovascular health" was performed. In the present review, focus was maintained on the evidence for the use of vitamin supplements in the prevention of major cardiovascular events and/or the maintenance of cardiovascular health by comprehensively reviewing all previous studies indexed in PubMed. Studies with clinical 'hard' end-points were included only. RESULTS A total of 87 studies met the inclusion criteria and were reviewed in the present article. High-quality evidence suggesting benefits for the use of vitamin supplements to maintain or improve cardiovascular health in people is minimal to non-existent. CONCLUSIONS Vitamin supplementation does not improve clinical cardiovascular outcomes in general population. Counseling on the importance of maintaining a healthy lifestyle with adequate and nutritious food intake seems more appropriate to improve and maintain cardiovascular health.
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Affiliation(s)
- Bahadir Simsek
- Cerrahpasa Medical School, Istanbul University-Cerrahpasa, 34098, Fatih/Istanbul, Turkey.
| | - Atakan Selte
- Cerrahpasa Medical School, Istanbul University-Cerrahpasa, 34098, Fatih/Istanbul, Turkey.
| | - Bugra Han Egeli
- Graduate Medical Sciences, Boston University School of Medicine, 72 E Concord St L-317, 02118, Boston, MA, USA.
| | - Ufuk Çakatay
- Cerrahpasa Medical School, Department of Medical Biochemistry, Istanbul University-Cerrahpasa, 34098, Fatih/Istanbul, Turkey.
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Non-Musculoskeletal Benefits of Vitamin D beyond the Musculoskeletal System. Int J Mol Sci 2021; 22:ijms22042128. [PMID: 33669918 PMCID: PMC7924658 DOI: 10.3390/ijms22042128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Vitamin D, a fat-soluble prohormone, is endogenously synthesized in response to sunlight or taken from dietary supplements. Since vitamin D receptors are present in most tissues and cells in the body, the mounting understanding of the role of vitamin D in humans indicates that it does not only play an important role in the musculoskeletal system, but has beneficial effects elsewhere as well. This review summarizes the metabolism of vitamin D, the research regarding the possible risk factors leading to vitamin D deficiency, and the relationships between vitamin D deficiency and numerous illnesses, including rickets, osteoporosis and osteomalacia, muscle weakness and falls, autoimmune disorders, infectious diseases, cardiovascular diseases (CVDs), cancers, and neurological disorders. The system-wide effects of vitamin D and the mechanisms of the diseases are also discussed. Although accumulating evidence supports associations of vitamin D deficiency with physical and mental disorders and beneficial effects of vitamin D with health maintenance and disease prevention, there continue to be controversies over the beneficial effects of vitamin D. Thus, more well-designed and statistically powered trials are required to enable the assessment of vitamin D’s role in optimizing health and preventing disease.
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Wan J, Yuan J, Li X, Bao Y, Hou Y, Li Z, Tan SC, Low TY, Chu Y. Association between serum vitamin D levels and venous thromboembolism (VTE): A systematic review and meta-analysis of observational studies. Complement Ther Med 2020; 54:102579. [PMID: 33183675 DOI: 10.1016/j.ctim.2020.102579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Although many studies have attempted to unravel the relationship between vitamin D deficiency and the incidence of VTE, the results remained inconsistent. To address this discrepancy, we performed a systematic review and meta-analysis to precisely disentangle the relationship between serum vitamin D levels and VTE risk. METHODS The Web of Science, Scopus, PubMed/Medline, Embase, and Google Scholar databases were searched for all available observational studies that reported the risk of venous thromboembolism (VTE) based on serum vitamin D levels categories. The search was performed up to March 2020. RESULTS Seven studies were included. The overall analysis showed a significantly increased risk of VTE in subjects with low levels of serum vitamin D compared with those with normal vitamin D levels (RR = 1.34; 95% CI: 1.07-1.69; P = 0.011). In a sensitivity analysis, we did not observe a significant effect of any individual study on the combined effect sizes. Nevertheless, significant heterogeneity was present among the studies (Cochrane Q test, p = 0.018, I2 = 61%). In the stratified analysis, low vitamin D levels were positively associated with an increased risk of VTE in prospective population-based studies (RR = 1.31; 95% CI: 1.06-1.61; P = 0.010) and in subjects below 60 years old (RR = 1.28; 95% CI: 1.07-1.54; P = 0.060). CONCLUSION our systematic review and meta-analysis showed that a low serum vitamin D level was indeed associated with an increased risk of VTE.
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Affiliation(s)
- Jia Wan
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming City, Yunnan Province, 650021 China
| | - Jie Yuan
- Department of Cardiovascul, People's Hospital of Xinjiang Uygur Autonomous Region, wulumuqi, Xinjiang, 830000, China
| | - Xiaogang Li
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming City, Yunnan Province, 650021 China
| | - Yan Bao
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming City, Yunnan Province, 650021 China
| | - Yi Hou
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming City, Yunnan Province, 650021 China
| | - Zhaoxiang Li
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming City, Yunnan Province, 650021 China
| | - Shing Cheng Tan
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Teck Yew Low
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yan Chu
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming City, Yunnan Province, 650021 China.
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Kouvari M, Panagiotakos DB, Chrysohoou C, Yannakoulia M, Georgousopoulou EN, Tousoulis D, Pitsavos C. Dietary vitamin D intake, cardiovascular disease and cardiometabolic risk factors: a sex‐based analysis from the ATTICA cohort study. J Hum Nutr Diet 2020; 33:708-717. [DOI: 10.1111/jhn.12748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- M. Kouvari
- Department of Nutrition and Dietetics School of Health Science and Education Harokopio University Athens Greece
| | - D. B. Panagiotakos
- Department of Nutrition and Dietetics School of Health Science and Education Harokopio University Athens Greece
- Faculty of Health University of Canberra Canberra ACT Australia
| | - C. Chrysohoou
- School of Medicine First Cardiology Clinic University of Athens Athinon Greece
| | - M. Yannakoulia
- Department of Nutrition and Dietetics School of Health Science and Education Harokopio University Athens Greece
| | - E. N. Georgousopoulou
- Department of Nutrition and Dietetics School of Health Science and Education Harokopio University Athens Greece
- School of Medicine The University of Notre Dame Sydney NSW Australia
| | - D. Tousoulis
- School of Medicine First Cardiology Clinic University of Athens Athinon Greece
| | - C. Pitsavos
- School of Medicine First Cardiology Clinic University of Athens Athinon Greece
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Abstract
The relationship between coronary artery disease (CAD) and low serum 25-hydroxyvitamin D (25(OH)D) levels has emerged. Postmenopausal (PM) women are at increased risk of CAD and vitamin D (VitD) deficiency.To investigate the relationship between CAD and VitD levels in PM women.This case-control study included 93 consecutive female patients aged 50 to 79 years old undergoing coronary angiography for evaluation of CAD and 119 age-matched controls. Serum 25(OH)D concentrations were classed as adequate (serum 25(OH)D: ≥20 ng/mL); insufficient (serum 25(OH)D: 10 to <20 ng/mL); and deficient (serum 25(OH)D: <10 ng/mL). Major cardiovascular risk factors were also explored.CAD occurred in 67/127 (52.8%) patients with VitD deficiency; 21/66 (31.8%) patients that were VitD insufficient; and in 5/19 (26.3%) patients with adequate VitD levels. Multivariate regression analysis suggested that a deficiency of VitD increased CAD (odds ratio = 2.891; 95% confidence interval = 1.459-7.139, P < .001).VitD deficiency should be evaluated in PM women as a possible cause of CAD.
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Affiliation(s)
| | - Yan-Yan Li
- Department of cardiac surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Gholami F, Moradi G, Zareei B, Rasouli MA, Nikkhoo B, Roshani D, Ghaderi E. The association between circulating 25-hydroxyvitamin D and cardiovascular diseases: a meta-analysis of prospective cohort studies. BMC Cardiovasc Disord 2019; 19:248. [PMID: 31699030 PMCID: PMC6836514 DOI: 10.1186/s12872-019-1236-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is a controversy about the association between vitamin D and cardiovascular diseases (CVDs). The effect of serum 25-OH-vitD on the risk of CVDs was evaluated. METHODS Major electronic databases including Scopus, Science Direct, and PubMed were searched. All prospective cohort studies on the relationship between vitamin D status and CVDs conducted between April 2000 and September 2017 were included, regardless language. The study participants were evaluated regardless of their age, sex, and ethnicity. The Newcastle-Ottawa Scale was used to assess the quality of the studies. Two investigators independently selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effects model was used to combine the results. RESULTS A meta-analysis of 25 studies with 10,099 cases of CVDs was performed. In general, a decrease in the level of vitamin D was associated with a higher relative risk of CVDs (incidence-mortality combined) (RR = 1.44, 95% CI: 1.24-1.69). This accounts for 54% of CVDs mortality rate (RR = 1.54, 95% CI: 1.29-1.84(. However, no significant relationship was observed between the vitamin D status and incidence of CVDs (RR = 1.18, 95% CI: 1-1.39). In general, low serum vitamin D level increased the risk of CVD by 44% (RR = 1.44, 95% CI: 1.24-1.69). It also increased the risk of CVD mortality (RR = 1.54, 95% CI: 1.29-1.84) and incidence rates (RR = 1.18, 95% CI: 1-1.39). CONCLUSIONS The findings showed that vitamin D deficiency increases the CVDs mortality rate. Due to the limited number of studies on patients of the both genders, further research is suggested to separately evaluate the effect of vitamin D status on CVD in men and women.
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Affiliation(s)
- Fatemeh Gholami
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bushra Zareei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Vice Chancellor for Educational and Research, Clinical Research Development Unit, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Aziz Rasouli
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. .,Vice Chancellor for Educational and Research, Clinical Research Development Unit, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Bahram Nikkhoo
- Department of Pathology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Daem Roshani
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Ghaderi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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13
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Yang J, Ou-Yang J, Huang J. Low serum vitamin D levels increase the mortality of cardiovascular disease in older adults: A dose-response meta-analysis of prospective studies. Medicine (Baltimore) 2019; 98:e16733. [PMID: 31441845 PMCID: PMC6716685 DOI: 10.1097/md.0000000000016733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Lower circulating vitamin D is common in older adults and may be a potential reversible risk factor for cardiovascular disease (CVD) in older adults, however, presented controversial results.Database was searched update to February 2018. Key data were extracted from eligible studies. Dose-response meta-analysis were conducted for synthesizing data from eligible studies.A total of 13 eligible studies involving 21,079 participants were included in this meta-analysis. Person with lower 25-hydroxyvitamin D status (25 (OH)D level <50 nmol/L) appeared to have higher mortality of CVD in older adults (RR = 1.54, 95% CI 1.24-1.91). Furthermore, a significantly higher mortality of CVD in older adults was observed for the deficient (<25 nmol/L; RR = 1.47, 95% CI 1.15-1.81) and insufficient (25-50 nmol/L; RR = 1.16, 95% CI 1.04-1.27) categories of 25 (OH)D, compared to the reference category of >75 nmol/L. Additionally, decrease of 10 nmol/L 25-hydroxyvitamin D was associated with a 7% incremental in the risk of CVD mortality in older adults.Considering these promising results, circulating vitamin D is associated with CVD mortality increment in older adults.
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Affiliation(s)
- Jun Yang
- Department of Medical College, Tianmen Vocational College
| | | | - Ji Huang
- Department of Neurology, Tianmen First People's Hospital, Tianmen, Hubei Province, China
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14
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Kouvari M, Panagiotakos DB. Vitamin D status, gender and cardiovascular diseases: a systematic review of prospective epidemiological studies. Expert Rev Cardiovasc Ther 2019; 17:545-555. [DOI: 10.1080/14779072.2019.1637255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Matina Kouvari
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Canberra, Australia
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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15
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Mohammad AM, Shammo NA, Jasem JA. Vitamin D status in acute myocardial infarction: a case-control study. Cardiovasc Endocrinol Metab 2018; 7:93-96. [PMID: 31646291 PMCID: PMC6739859 DOI: 10.1097/xce.0000000000000160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association of vitamin D deficiency with coronary artery disease (CAD) is controversial. This study seeks the association between vitamin D deficiency and acute myocardial infarction (MI) in Iraq. PATIENTS AND METHODS A total of 104 patients with acute MI and 104 healthy controls were studied throughout 2015. Their demographic, cardiovascular risk factors, and clinical characteristics were recorded. Serum vitamin D measurement was carried out for all patients. RESULTS Vitamin D was more deficient in cases than controls; the number of cases was 60 (57.7%) and 53 (51%), respectively. However, a statistically significant difference (P=0.6) was not obtained. In the patient group, type 2 diabetes mellitus showed a strong association with vitamin D deficiency; there were 31 (81.6%) diabetic patients and 29 (43.9%) nondiabetic patients (P<0.001). CONCLUSION No statistical association between vitamin D deficiency and acute MI was found. Nevertheless, a strong association between vitamin D deficiency and acute MI with type 2 diabetes mellitus was seen.
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Affiliation(s)
| | | | - Jagar A. Jasem
- Department of Medicine, College of Medicine, University of Duhok
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16
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Leu Agelii M, Lehtinen-Jacks S, Zetterberg H, Sundh V, Björkelund C, Lissner L. Low vitamin D status in relation to cardiovascular disease and mortality in Swedish women - Effect of extended follow-up. Nutr Metab Cardiovasc Dis 2017; 27:1143-1151. [PMID: 29170060 DOI: 10.1016/j.numecd.2017.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/17/2017] [Accepted: 10/11/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS The impact of vitamin D concentrations on subsequent cardiovascular disease (CVD) and overall mortality has been generally examined for periods under two decades. The magnitude of the association may depend on follow-up length. We aimed to investigate the relationship between baseline vitamin D and risk of total CVD, stroke and all-cause mortality over three decades of follow-up. Secondly, we aimed to assess how follow-up affects the associations. METHODS AND RESULTS Concentrations of 25-hydroxyvitamin D (25D) were measured in a population-based sample of 1227 middle-aged women using serum collected at baseline and categorized into low (lowest 25D quartile) vs high 25D status (upper three 25D quartiles). Hazard ratio (HR) of the endpoints was estimated for low 25D. The impact of follow-up was examined in intermediary analyses where follow-up was interrupted up to four times, each time decreasing it by five years. There were 596 cardiovascular events and 635 participants died. During the first 17 years, the low 25D group experienced a 29% higher CVD risk and 3.3-fold higher stroke risk after accounting for confounders. Longer follow-up diminished significantly these risks and 25D status had no contribution at 32 years. For mortality, the decline over time was less dramatic, with HR = 1.96 (1.25; 3.08) at 17 years and HR = 1.42 (1.17; 1.72) at 37 years. CONCLUSION Low 25D status increased the risk for all endpoints, but a lengthy follow-up diminished these risks towards the null. The impact of follow-up depends on the outcome. Future studies of 25D and disease should use repeated 25D assessments.
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Affiliation(s)
- M Leu Agelii
- Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - S Lehtinen-Jacks
- Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - H Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - V Sundh
- Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Björkelund
- Section for Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L Lissner
- Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Lerstad G, Grimnes G, Brækkan SK, Vik A, Brox J, Svartberg J, Jorde R, Hansen JB, Brodin EE. Serum levels of vitamin D are not associated with future risk of venous thromboembolism. Thromb Haemost 2017; 109:885-90. [DOI: 10.1160/th12-10-0728] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/09/2013] [Indexed: 01/20/2023]
Abstract
SummaryPrevious studies have provided indirect evidence for a possible association between vitamin D status and risk of venous thromboembolism (VTE). However, no study has so far investigated the association between serum levels of 25-hydroxyvitamin D (25(OH)D), the biomarker of vitamin D status, and risk of VTE. The aim of our study was to investigate whether high levels of 25(OH)D were associated with decreased risk of VTE in a prospective population-based study. Serum levels of 25(OH)D were measured in 6,021 men and women, aged 25–84 years, who participated in the Tromsø Study in 1994–1995. Incident VTE-events were registered from date of inclusion through the end of follow-up, September 1, 2007. Cox-regression models were used to calculate hazard ratios (HR) with 95% confidence interval (CI) for VTE. There were 201 incident VTE-events during a median of 10.7 years of follow-up. The risk of VTE did not decrease per one standard deviation (SD) (19.8 nmol/l) increase in serum 25(OH)D (multivariable HR 1.02; 95% CI 0.91–1.22). Moreover, subjects with serum 25(OH)D ≥ 70 nmol/l (upper quartile) did not have decreased risk of VTE compared to those ≤ 44 nmol/l (lower quartile) in age- and sex-adjusted analysis (HR 0.91, 95% CI: 0.60–1.37, p for trend across quartiles 0.9) or multivariable analysis adjusted for age, sex, body mass index, smoking, and physical activity (HR 0.76, 95% CI: 0.45–1.28, p for trend across quartiles 0.9). Subgroup analyses showed no associations between serum levels of 25(OH)D and unprovoked or provoked VTE. In conclusion, in our study, normal serum levels of 25(OH)D were not associated with future risk of VTE, suggesting that vitamin D status does not play an important role in the pathogenesis of VTE. However, our findings did not apply to subjects with vitamin D deficiency (< 30 nmol/l) due to lack of statistical power among these subjects.
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18
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Bikle DD. Extraskeletal actions of vitamin D. Ann N Y Acad Sci 2017; 1376:29-52. [PMID: 27649525 DOI: 10.1111/nyas.13219] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/26/2016] [Accepted: 08/03/2016] [Indexed: 12/16/2022]
Abstract
The vitamin D receptor (VDR) is found in nearly all, if not all, cells in the body. The enzyme that produces the active metabolite of vitamin D and ligand for VDR, namely CYP27B1, likewise is widely expressed in many cells of the body. These observations indicate that the role of vitamin D is not limited to regulation of bone and mineral homeostasis, as important as that is. Rather, the study of its extraskeletal actions has become the major driving force behind the significant increase in research articles on vitamin D published over the past several decades. A great deal of information has accumulated from cell culture studies, in vivo animal studies, and clinical association studies that confirms that extraskeletal effects of vitamin D are truly widespread and substantial. However, randomized, placebo-controlled clinical trials, when done, have by and large not produced the benefits anticipated by the in vitro cell culture and in vivo animal studies. In this review, I will examine the role of vitamin D signaling in a number of extraskeletal tissues and assess the success of translating these findings into treatments of human diseases affecting those extracellular tissues.
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Affiliation(s)
- Daniel D Bikle
- Departments of Medicine and Dermatology, Veterans Affairs Medical Center and University of California, San Francisco, San Francisco, California.
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19
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Zhang R, Li B, Gao X, Tian R, Pan Y, Jiang Y, Gu H, Wang Y, Wang Y, Liu G. Serum 25-hydroxyvitamin D and the risk of cardiovascular disease: dose-response meta-analysis of prospective studies. Am J Clin Nutr 2017; 105:810-819. [PMID: 28251933 DOI: 10.3945/ajcn.116.140392] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
Background: During the past decade, an increasing number of prospective studies have focused on the association between vitamin D and cardiovascular disease (CVD). However, the evidence on the relation between serum 25-hydroxyvitamin D [25(OH)D] and the risk of overt CVD is inconclusive.Objective: We performed a dose-response meta-analysis to summarize and prospectively quantify the RR of low serum 25(OH)D concentration and total CVD (events and mortality).Design: We identified relevant studies by searching PubMed and EMBASE up to December 2015 and by hand-searching reference lists. Prospective studies based on the general population and reported RRs and 95% CIs were included. A random-effects model was used to calculate the pooled RRs. Nonlinear association was assessed by using restricted cubic spline analyses.Results: A total of 34 publications with 180,667 participants were eligible for the meta-analysis. We included 32 publications (27 independent studies) for total CVD events and 17 publications (17 independent studies) for CVD mortality. We observed an inverse association between serum 25(OH)D and total CVD events and CVD mortality, and the pooled RRs per 10-ng/mL increment were 0.90 (95% CI: 0.86, 0.94) for total CVD events and 0.88 (95% CI: 0.80, 0.96) for CVD mortality. A nonlinear association was detected for total CVD events (P-nonlinear < 0.001) and CVD mortality (P-nonlinear = 0.022).Conclusion: Serum 25(OH)D concentration was inversely associated with total CVD events and CVD mortality from the observed studies.
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Affiliation(s)
- Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Bohong Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, State College, PA
| | - Rui Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Hongqiu Gu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; .,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
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20
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Skaaby T, Thuesen BH, Linneberg A. Vitamin D, Cardiovascular Disease and Risk Factors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:221-230. [DOI: 10.1007/978-3-319-56017-5_18] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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Roseland JM, Patterson KY, Andrews KW, Phillips KM, Phillips MM, Pehrsson PR, Dufresne GL, Jakobsen J, Gusev PA, Savarala S, Nguyen QV, Makowski AJ, Scheuerell CR, Larouche GP, Wise SA, Harnly JM, Williams JR, Betz JM, Taylor CL. Interlaboratory Trial for Measurement of Vitamin D and 25-Hydroxyvitamin D [25(OH)D] in Foods and a Dietary Supplement Using Liquid Chromatography-Mass Spectrometry. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2016; 64:3167-3175. [PMID: 27045951 PMCID: PMC4934653 DOI: 10.1021/acs.jafc.5b05016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Assessment of total vitamin D intake from foods and dietary supplements (DSs) may be incomplete if 25-hydroxyvitamin D [25(OH)D] intake is not included. However, 25(OH)D data for such intake assessments are lacking, no food or DS reference materials (RMs) are available, and comparison of laboratory performance has been needed. The primary goal of this study was to evaluate whether vitamin D3 and 25(OH)D3 concentrations in food and DS materials could be measured with acceptable reproducibility. Five experienced laboratories from the United States and other countries participated, all using liquid chromatography tandem-mass spectrometry but no common analytical protocol; however, various methods were used for determining vitamin D3 in the DS. Five animal-based materials (including three commercially available RMs) and one DS were analyzed. Reproducibility results for the materials were acceptable. Thus, it is possible to obtain consistent results among experienced laboratories for vitamin D3 and 25(OH)D3 in foods and a DS.
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Affiliation(s)
- Janet M Roseland
- USDA Agricultural Research Service, Nutrient Data Laboratory, 10300 Baltimore Avenue, Building 005, BARC-West, Beltsville, MD 20705
| | - Kristine Y Patterson
- USDA Agricultural Research Service, Nutrient Data Laboratory, 10300 Baltimore Avenue, Building 005, BARC-West, Beltsville, MD 20705
| | - Karen W Andrews
- USDA Agricultural Research Service, Nutrient Data Laboratory, 10300 Baltimore Avenue, Building 005, BARC-West, Beltsville, MD 20705
| | - Katherine M Phillips
- Virginia Tech, Biochemistry Department (0308), 304 Engel Hall, Blacksburg, VA 24061
| | - Melissa M Phillips
- Chemical Sciences Division, National Institute of Standards and Technology, 100 Bureau Drive, MS 8392, Gaithersburg, MD 20899-8392
| | - Pamela R Pehrsson
- USDA Agricultural Research Service, Nutrient Data Laboratory, 10300 Baltimore Avenue, Building 005, BARC-West, Beltsville, MD 20705
| | - Guy L Dufresne
- Health Canada, Food and Nutrition Laboratory, 1001, St-Laurent Ouest, Longueuil, Québec, Canada J4K IC7
| | - Jette Jakobsen
- Division of Food Chemistry, National Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Pavel A Gusev
- USDA Agricultural Research Service, Nutrient Data Laboratory, 10300 Baltimore Avenue, Building 005, BARC-West, Beltsville, MD 20705
| | - Sushma Savarala
- USDA Agricultural Research Service, Nutrient Data Laboratory, 10300 Baltimore Avenue, Building 005, BARC-West, Beltsville, MD 20705
| | - Quynhanh V Nguyen
- USDA Agricultural Research Service, Nutrient Data Laboratory, 10300 Baltimore Avenue, Building 005, BARC-West, Beltsville, MD 20705
| | | | | | - Guillaume P Larouche
- Health Canada, Food and Nutrition Laboratory, 1001, St-Laurent Ouest, Longueuil, Québec, Canada J4K IC7
| | - Stephen A Wise
- Chemical Sciences Division, National Institute of Standards and Technology, 100 Bureau Drive, MS 8392, Gaithersburg, MD 20899-8392
| | - James M Harnly
- USDA Agricultural Research Service, Food Composition and Method Development Laboratory, 10300 Baltimore Avenue, Building 161, BARC-East, Beltsville, MD 20705
| | - Juhi R Williams
- USDA Agricultural Research Service, Nutrient Data Laboratory, 10300 Baltimore Avenue, Building 005, BARC-West, Beltsville, MD 20705
| | - Joseph M Betz
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., 3B01, MSC 7517,Bethesda, MD 20892
| | - Christine L Taylor
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., 3B01, MSC 7517,Bethesda, MD 20892
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22
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Muscogiuri G, Nuzzo V, Gatti A, Zuccoli A, Savastano S, Di Somma C, Pivonello R, Orio F, Colao A. Hypovitaminosis D: a novel risk factor for coronary heart disease in type 2 diabetes? Endocrine 2016; 51:268-73. [PMID: 25931413 DOI: 10.1007/s12020-015-0609-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
Abstract
Vitamin D (25(OH)D) levels have been associated with cardiovascular disease. Thus, the aim of our study was to investigate the association of 25(OH)D levels with coronary heart disease (CHD) in 698 consecutive type 2 diabetic outpatients. 698 consecutive type 2 diabetic outpatients (25.2 % men, age 66 ± 9 years) and 100 (90 % men, age 65 ± 13 years) age-matched non-diabetic volunteers were enrolled. 25(OH)D assay and the main cardiovascular risk factors were explored. 25(OH)D concentration was 22 ± 10 ng/ml in control subjects and 18.23 ± 10 ng/ml in diabetic patients (p < 0.01). The prevalence of hypovitaminosis D was higher in diabetic patients than in control subjects (90 vs. 83 %, p < 0.01). Diabetic subjects with hypovitaminosis D had higher prevalence of high values of A1C (p < 0.01), BMI (p < 0.01), LDL cholesterol (p < 0.01), triglycerides (p < 0.01), and glycemia (p < 0.01) than their vitamin D-sufficient counterparts. 25(OH)D and HDL cholesterol were lower (p < 0.01), while BMI (p < 0.01), age (p < 0.01), systolic (p < 0.01) and diastolic blood pressure (p < 0.01), diabetes duration (p < 0.01), A1C (p < 0.01), glycemia (p < 0.01), fibrinogen (p < 0.01), triglycerides (p < 0.01), and total (p < 0.01) and LDL cholesterol (p < 0.01) were higher in diabetic subjects with CHD than diabetic subjects without CHD. At the logistic regression analysis, the association of vitamin D with CHD was lost, while sex (p = 0.026), diabetes duration (p = 0.023), and age (p = 0.024) were the most powerful predictors of CHD. The current study demonstrates that 25(OH)D does not have a direct effect on CHD but may have an indirect effect mediated by cardiovascular risk factors such as diabetes duration, age, and sex.
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Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", via S. Pansini 5, 80131, Naples, Italy.
| | - Vincenzo Nuzzo
- Internal Medicine Unit, San Gennaro Hospital, Naples, Italy
| | - Adriano Gatti
- Diabetology Unit, San Gennaro Hospital, Naples, Italy
| | | | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", via S. Pansini 5, 80131, Naples, Italy
| | | | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", via S. Pansini 5, 80131, Naples, Italy
| | - Francesco Orio
- Department of Endocrinology, University "Parthenope" Naples, Naples, Italy
- Endocrinology of Fertile Age, "S. Giovanni di Dio e Ruggi d'Aragona" University Hospital Salerno, Salerno, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", via S. Pansini 5, 80131, Naples, Italy
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23
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Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. Physiol Rev 2016; 96:365-408. [PMID: 26681795 PMCID: PMC4839493 DOI: 10.1152/physrev.00014.2015] [Citation(s) in RCA: 1087] [Impact Index Per Article: 135.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
1,25-Dihydroxvitamin D3 [1,25(OH)2D3] is the hormonally active form of vitamin D. The genomic mechanism of 1,25(OH)2D3 action involves the direct binding of the 1,25(OH)2D3 activated vitamin D receptor/retinoic X receptor (VDR/RXR) heterodimeric complex to specific DNA sequences. Numerous VDR co-regulatory proteins have been identified, and genome-wide studies have shown that the actions of 1,25(OH)2D3 involve regulation of gene activity at a range of locations many kilobases from the transcription start site. The structure of the liganded VDR/RXR complex was recently characterized using cryoelectron microscopy, X-ray scattering, and hydrogen deuterium exchange. These recent technological advances will result in a more complete understanding of VDR coactivator interactions, thus facilitating cell and gene specific clinical applications. Although the identification of mechanisms mediating VDR-regulated transcription has been one focus of recent research in the field, other topics of fundamental importance include the identification and functional significance of proteins involved in the metabolism of vitamin D. CYP2R1 has been identified as the most important 25-hydroxylase, and a critical role for CYP24A1 in humans was noted in studies showing that inactivating mutations in CYP24A1 are a probable cause of idiopathic infantile hypercalcemia. In addition, studies using knockout and transgenic mice have provided new insight on the physiological role of vitamin D in classical target tissues as well as evidence of extraskeletal effects of 1,25(OH)2D3 including inhibition of cancer progression, effects on the cardiovascular system, and immunomodulatory effects in certain autoimmune diseases. Some of the mechanistic findings in mouse models have also been observed in humans. The identification of similar pathways in humans could lead to the development of new therapies to prevent and treat disease.
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Affiliation(s)
- Sylvia Christakos
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey; and Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Puneet Dhawan
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey; and Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Annemieke Verstuyf
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey; and Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Lieve Verlinden
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey; and Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Geert Carmeliet
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey; and Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
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Andro M, Delluc A, Moineau MP, Tromeur C, Gouillou M, Lacut K, Carré JL, Gentric A, Le Gal G. Serum levels of 25(OH)D are not associated with venous thromboembolism in the elderly population. A case-control study. Thromb Haemost 2015; 115:169-75. [PMID: 26538494 DOI: 10.1160/th15-02-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/15/2015] [Indexed: 01/08/2023]
Abstract
The prevalence of both vitamin D deficiency and venous thromboembolism (VTE) is important in the elderly. Previous studies have provided evidence for a possible association between vitamin D status and the risk of VTE. Thus, we aimed to investigate the association between vitamin D levels and VTE in the population aged 75 and over included in the EDITH case-control study. The association between vitamin D status and VTE was analysed. We also analysed the monthly and seasonal variations of VTE and vitamin D. Between May 2000 and December 2009, 340 elderly patients (mean age 81.5 years, 32% men) with unprovoked VTE and their controls were included. The univariate and multivariate analysis found no significant association between serum levels of vitamin D and the risk of unprovoked VTE. In the unadjusted analysis, a higher BMI was statistically associated with an increased risk of VTE (OR 1.09; 95% CI 1.05-1.13) whereas a better walking capacity and living at home were associated with a decreased rate of VTE: OR 0.57; 95% CI 0.36-0.90 and 0.40; 95% CI 0.25-0.66, respectively. Although not significant, more VTE events occurred during winter (p=0.09). No seasonal variations of vitamin D levels were found (p=0.11). In conclusion, in contrast with previous reports our findings suggest that vitamin D is not associated with VTE in the elderly population.
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Affiliation(s)
- Marion Andro
- Marion Andro, Médecine Gériatrique, CHRU de la Cavale Blanche, 29200 Brest, France, Tel.: +33 298 34 71 91, Fax: +33 2 98 34 71 93, E-mail:
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Vitamin D for the prevention of cardiovascular disease: Are we ready for that? Atherosclerosis 2015; 241:729-40. [PMID: 26135478 DOI: 10.1016/j.atherosclerosis.2015.06.034] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/16/2015] [Accepted: 06/16/2015] [Indexed: 11/23/2022]
Abstract
A general concept of clinical benefit of vitamin D supplementation has emerged from the evidence in prevention of osteoporosis. From the cardiovascular point of view, clinical benefit of such supplementation remains less clear. Studies in vitro and in animal models demonstrated the expression of vitamin D receptors in endothelial cells, vascular smooth muscle and cardiomyocytes. Vitamin D has been directly implicated in endothelium-mediated vasodilation, anti-coagulant activity and inhibition of the inflammatory response. Indirectly, it may favor the reduction of blood pressure, myocardial hypertrophy and ventricular arrhythmias. In contrast to these mechanistic findings, cross-sectional, longitudinal and small clinical trials have not been consistent in demonstrating association between cardiovascular events and vitamin D. Besides, methodological issues in the tests for serum levels of vitamin D may also contribute to this puzzle. Hence, in the current state of knowledge, it may be too early to consider or to rule out vitamin D as a tool to either estimate or mitigate residual cardiovascular risk. In this review, we discuss recent advances and potential limitations in mechanistic and clinical evidences that are outlining the framework of interaction between vitamin D and cardiovascular risk.
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El-Fakhri N, McDevitt H, Shaikh MG, Halsey C, Ahmed SF. Vitamin D and its effects on glucose homeostasis, cardiovascular function and immune function. Horm Res Paediatr 2015; 81:363-78. [PMID: 24776698 DOI: 10.1159/000357731] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/04/2013] [Indexed: 11/19/2022] Open
Abstract
In recent years there has been increasing interest in the non-skeletal effects of vitamin D. It has been suggested that vitamin D deficiency may influence the development of diabetes, cardiovascular dysfunction and autoimmune diseases. This review focuses on the current knowledge of the effects of vitamin D and its deficiency on cardiovascular function, glucose homeostasis and immune function, with a particular focus on children. Although, there is good evidence to show that there is an association between vitamin D deficiency and an abnormality of the above systems, there is little evidence to show that vitamin D supplementation leads to an improvement in function, especially in childhood.
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Affiliation(s)
- N El-Fakhri
- School of Medicine, University of Glasgow, Royal Hospital for Sick Children, Glasgow, UK
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Ma H, Lin H, Hu Y, Li X, He W, Jin X, Gao J, Zhao N, Liu Z, Gao X. Serum 25-hydroxyvitamin D levels are associated with carotid atherosclerosis in normotensive and euglycemic Chinese postmenopausal women: the Shanghai Changfeng study. BMC Cardiovasc Disord 2014; 14:197. [PMID: 25528383 PMCID: PMC4289590 DOI: 10.1186/1471-2261-14-197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/16/2014] [Indexed: 12/03/2022] Open
Abstract
Background The role of serum 25-hydroxyvitamin D (25 (OH) D) in atherogenesis is unclear. We investigated whether the 25 (OH) D is independently associated with the carotid intima–media thickness (CIMT) and carotid plaques in normotensive and euglycemic postmenopausal women. Methods A total of 671 normotensive and euglycemic postmenopausal women (mean age, 58.8 years) were enrolled from the Changfeng Study. A standard interview, anthropometrics measurements and laboratory analyses were performed for each participant. Bilateral CIMTs were measured using ultrasonography, and the presence of carotid plaques was assessed. The serum 25 (OH) D was measured using electrochemiluminescence immunoassay. Results Serum 25 (OH) D was 43.6 ± 18.2 nmol/L in the postmenopausal women. Compared with subjects with 25 (OH) D in the first, second and third quartiles, subjects with 25 (OH) D in the fourth quartile had decreased CIMT and prevalence of carotid plaque (0.684 ± 0.009 mm vs 0.719 ± 0.009 mm, 0.708 ± 0.009 mm and 0.709 ± 0.009 mm; 10.8% vs 19.0%, 14.8% and 16.8%, respectively). After adjusting for conventional CVD risk factors, PTH, liver and renal function, postmenopausal women with 25 (OH) D in the fourth quartile still had lower CIMT than those in the first, second and third quartiles (p = 0.039) and the subjects in the fourth quartile had a 0.421-fold decreased risk of carotid plaques relative to those in the lowest quartile (95% confidence interval 0.209 to 0.848). Conclusions These results suggest serum 25 (OH) D is independently and inversely associated with carotid atherosclerosis in postmenopausal women with normal blood pressure and normal glucose tolerance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xin Gao
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai 200032, China.
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Vitamin D and Cardiometabolic Disorders. High Blood Press Cardiovasc Prev 2014; 21:251-6. [DOI: 10.1007/s40292-014-0060-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 05/31/2014] [Indexed: 12/31/2022] Open
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Bajaj A, Stone KL, Peters K, Parimi N, Barrett-Connor E, Bauer D, Cawthon PM, Ensrud KE, Hoffman AR, Orwoll E, Schernhammer ES. Circulating vitamin D, supplement use, and cardiovascular disease risk: the MrOS Sleep Study. J Clin Endocrinol Metab 2014; 99:3256-62. [PMID: 24670083 PMCID: PMC4154079 DOI: 10.1210/jc.2013-4178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Evidence suggests an inverse association between circulating 25(OH) vitamin D and cardiovascular disease (CVD). OBJECTIVE To determine the association between serum 25(OH) vitamin D and risk for CVD events. SETTING AND DESIGN From March 2000 to April 2002, participants were recruited for the Osteoporotic Fractures in Men (MrOS) study. Between December 2003 and March 2005, members of the MrOS cohort were invited to participate in the MrOS Sleep Study. Participants were recruited from 6 clinical centers across the United States and followed for a mean of 5.9 years. Three-thousand-one-hundred-thirty-five men ages 65 and older were included from the MrOS cohort, of whom 116 were excluded for missing vitamin D or CVD data. Participants were divided into two groups based on serum 25(OH) vitamin D levels, <20 ng/mL and ≥20 ng/mL. Participants were followed for CVD endpoints including coronary heart disease (CHD) and cerebrovascular events. Age- and multivariable-adjusted hazard ratios were calculated and stratified by use of vitamin D containing supplements. RESULTS We observed no significant association between circulating 25(OH) vitamin D and risk of CVD event (HR, 0.91; 95% confidence interval (CI), 0.73-1.13) and CHD event (HR, 0.81; 95% CI, 0.61-1.07). For cerebrovascular events, men with vitamin D deficiency exhibited a higher risk (HR, 1.44; 95% CI, 1.00-2.08) using the minimally adjusted model and after excluding supplement users (HR, 1.70; 95% CI, 1.02-2.83). CONCLUSIONS 25(OH) vitamin D was not associated with risk of CVD and CHD events. However, vitamin D deficiency may be associated with an increased risk of cerebrovascular events.
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Affiliation(s)
- Archna Bajaj
- Temple University Hospital (A.B.), Philadelphia, Pennsylvania 19140; California Pacific Medical Center Research Institute (K.L.S., K.P., N.P., E.B.-C., D.B., P.M.C., E.O.), San Francisco, California 94107; University of Minnesota and Minneapolis VA Health System (K.E.E.), Minneapolis, Minnesota 55417; Department of Medicine (A.R.H.), Stanford University School of Medicine, Stanford, California 94305; Channing Division of Network Medicine (E.S.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Division of Sleep Medicine (E.S.S.), Harvard Medical School, Boston, Massachusetts 02115; and Department of Epidemiology (E.S.S.), Harvard School of Public Health, Boston, Massachusetts 02115
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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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Kunadian V, Ford GA, Bawamia B, Qiu W, Manson JE. Vitamin D deficiency and coronary artery disease: a review of the evidence. Am Heart J 2014; 167:283-91. [PMID: 24576510 DOI: 10.1016/j.ahj.2013.11.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/01/2013] [Indexed: 01/17/2023]
Abstract
Coronary artery disease remains the leading cause of death in developed countries despite significant progress in primary prevention and treatment strategies. Older patients are at particularly high risk of poor outcomes following acute coronary syndrome and impaired nutrition, including low vitamin D levels, may play a role. The extraskeletal effects of vitamin D, in particular, its role in maintaining a healthy cardiovascular system are receiving increased attention. Longitudinal studies have demonstrated increased cardiovascular mortality and morbidity associated with vitamin D deficiency. Low vitamin D levels have been linked to inflammation, higher coronary artery calcium scores, impaired endothelial function and increased vascular stiffness. However, so far, few randomized controlled trials have investigated the potential benefits of vitamin D supplementation in preventing cardiovascular events, and most available trials have tested low doses of supplementation in relatively low-risk populations. Whether vitamin D supplementation will be beneficial among patients with coronary artery disease, including high risk older patients presenting with acute coronary syndrome, is unknown and warrants further investigation.
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Affiliation(s)
- Vijay Kunadian
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Gary A Ford
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bilal Bawamia
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Weiliang Qiu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Skaaby T, Husemoen LLN, Pisinger C, Jørgensen T, Thuesen BH, Fenger M, Linneberg A. Vitamin D status and incident cardiovascular disease and all-cause mortality: a general population study. Endocrine 2013; 43:618-25. [PMID: 23015273 DOI: 10.1007/s12020-012-9805-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/14/2012] [Indexed: 12/31/2022]
Abstract
Low vitamin D status has been associated with cardiovascular disease (CVD) and mortality primarily in selected groups, smaller studies, or with self-reported vitamin D intake. We investigated the association of serum vitamin D status with the incidence of a registry-based diagnosis of ischemic heart disease (IHD), stroke, and all-cause mortality in a large sample of the general population. A total of 9,146 individuals from the two population-based studies, Monica10 and Inter99, were included. Measurements of serum 25-hydroxyvitamin D at baseline were carried out using the IDS ISYS immunoassay system in Monica10 and High-performance liquid chromatography in Inter99. Information on CVDs and causes of death was obtained from Danish registries until 31 December 2008. There were 478 cases of IHD, 316 cases of stroke, and 633 deaths during follow-up (mean follow-up 10 years). Cox regression analyses with age as underlying time axis showed a significant association between vitamin D status and all-cause mortality with a HR = 0.95 (P = 0.005) per 10 nmol/l higher vitamin D level. We found no association between vitamin D status and incidence of IHD or stroke (HR = 1.01, P = 0.442 and HR = 1.00, P = 0.920, respectively). In this large general population study, the observed inverse association between serum vitamin D status and all-cause mortality was not explained by a similar inverse association with IHD or stroke.
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Affiliation(s)
- Tea Skaaby
- Research Centre for Prevention and Health, Glostrup Hospital, Nordre Ringvej 57, 2600, Glostrup, Denmark.
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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: 452] [Impact Index Per Article: 37.7] [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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Body JJ, Bergmann P, Boonen S, Devogelaer JP, Gielen E, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY. Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications. Osteoporos Int 2012; 23 Suppl 1:S1-23. [PMID: 22311111 PMCID: PMC3273686 DOI: 10.1007/s00198-011-1891-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/19/2011] [Indexed: 12/11/2022]
Abstract
UNLABELLED Drugs used for the prevention and the treatment of osteoporosis exert various favourable and unfavourable extra-skeletal effects whose importance is increasingly recognized notably for treatment selection. INTRODUCTION The therapeutic armamentarium for the prevention and the treatment of osteoporosis is increasingly large, and possible extra-skeletal effects of available drugs could influence the choice of a particular compound. METHODS The present document is the result of a national consensus, based on a systematic and critical review of the literature. RESULTS Observational research has suggested an inverse relationship between calcium intake and cardiovascular diseases, notably through an effect on blood pressure, but recent data suggest a possible deleterious effect of calcium supplements on cardiovascular risk. Many diverse studies have implicated vitamin D in the pathogenesis of clinically important non-skeletal functions or diseases, especially muscle function, cardiovascular disease, autoimmune diseases and common cancers. The possible effects of oral or intravenous bisphosphonates are well-known. They have been associated with an increased risk of oesophageal cancer or atrial fibrillation, but large-scale studies have not found any association with bisphosphonate use. Selective oestrogen receptor modulators have demonstrated favourable or unfavourable extra-skeletal effects that vary between compounds. Strontium ranelate has a limited number of non-skeletal effects. A reported increase in the risk of venous thromboembolism is not found in observational studies, and very rare cases of cutaneous hypersensitivity reactions have been reported. Denosumab has been introduced recently, and its extra-skeletal effects still have to be assessed. CONCLUSION Several non-skeletal effects of bone drugs are well demonstrated and influence treatment choices.
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Affiliation(s)
- J.-J. Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P. Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S. Boonen
- Center for Metabolic Bone Diseases, Katholieke University Leuven, Leuven, Belgium
| | - J.-P. Devogelaer
- Department of Rheumatology, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - E. Gielen
- Gerontology and Geriatrics Section, Department of Experimental Medicine, K.U.Leuven, Leuven, Belgium
| | - S. Goemaere
- Department of Rheumatology and Endocrinology, State University of Gent, Gent, Belgium
| | - J.-M. Kaufman
- Department of Endocrinology, State University of Gent, Gent, Belgium
| | - S. Rozenberg
- Department of Gynaecology–Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - J.-Y. Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Bone and Cartilage Metabolism Research Unit, CHU Centre-Ville, Policliniques L. BRULL, Quai Godefroid Kurth 45 (9ème étage), 4020 Liege, Belgium
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Pilz S, Tomaschitz A, März W, Drechsler C, Ritz E, Zittermann A, Cavalier E, Pieber TR, Lappe JM, Grant WB, Holick MF, Dekker JM. Vitamin D, cardiovascular disease and mortality. Clin Endocrinol (Oxf) 2011; 75:575-84. [PMID: 21682758 DOI: 10.1111/j.1365-2265.2011.04147.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A poor vitamin D status, i.e. low serum levels of 25-hydroxyvitamin D [25(OH)D], is common in the general population. This finding is of concern not only because of the classic vitamin D effects on musculoskeletal outcomes, but also because expression of the vitamin D receptor (VDR) and vitamin D metabolizing enzymes in the heart and blood vessels suggests a role of vitamin D in the cardiovascular system. VDR-knockout mice suffer from cardiovascular disease (CVD), and various experimental studies suggest cardiovascular protection by vitamin D, including antiatherosclerotic, anti-inflammatory and direct cardio-protective actions, beneficial effects on classic cardiovascular risk factors as well as suppression of parathyroid hormone (PTH) levels. In epidemiological studies, low levels of 25(OH)D are associated with increased risk of CVD and mortality. Data from randomized controlled trials (RCTs) are sparse and have partially, but not consistently, shown some beneficial effects of vitamin D supplementation on cardiovascular risk factors (e.g. arterial hypertension). We have insufficient data on vitamin D effects on cardiovascular events, but meta-analyses of RCTs indicate that vitamin D may modestly reduce all-cause mortality. Despite accumulating data suggesting that a sufficient vitamin D status may protect against CVD, we still must wait for results of large-scale RCTs before raising general recommendations for vitamin D in the prevention and treatment of CVD. In current clinical practice, the overall risks and costs of vitamin D supplementation should be weighed against the potential adverse consequences of untreated vitamin D deficiency.
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Affiliation(s)
- Stefan Pilz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
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