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Liu L, Cui S, Volpe SL, May NS, Sukumar D, DiMaria-Ghalili RA, Eisen HJ. Vitamin d deficiency and metabolic syndrome: The joint effect on cardiovascular and all-cause mortality in the United States adults. World J Cardiol 2022; 14:411-426. [PMID: 36161059 PMCID: PMC9350604 DOI: 10.4330/wjc.v14.i7.411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/25/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome (MetS) on cardiovascular disease (CVD) and all-cause mortality are still a matter of debate.
AIM To test the hypotheses that lower serum 25 hydroxyvitamin D [25(OH)D] concentrations (a marker of vitamin D level) and MetS have a long-term impact on the risk of CVD and all-cause mortality, and individuals with vitamin D deficiency can be identified by multiple factors.
METHODS A sample of 9094 adults, 20 to 90 years of age, who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994) were followed through December 2015 was analyzed. The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models. Classification and regression tree (CART) for machine learning was applied to classify individuals with vitamin D deficiency.
RESULTS Of 9094 participants, 30% had serum 25(OH)D concentrations < 20 ng/mL (defined as vitamin D deficiency), 39% had serum 25(OH)D concentrations between 20 to 29 ng/mL (insufficiency), and 31% had serum 25(OH)D concentrations ≥30 ng/mL (sufficiency). Prevalence of MetS was 28.4%. During a mean of 18 years follow-up, vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality. Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality (HR = 1.77, 95%CI: 1.22-2.58) and all-cause mortality (HR = 1.62, 95%CI: 1.26-2.09), followed by those with both vitamin D insufficiency and MetS for CVD mortality (HR = 1.59, 95%CI: 1.12-2.24), and all-cause mortality (HR = 1.41, 95%CI: 1.08-1.85). Meanwhile, vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS. Among the total study sample, CART analysis suggests that being non-Hispanic Black, having lower serum folate level, and being female were the first three predictors for those with serum 25(OH)D deficiency.
CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality. There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality. Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, United States
| | - Saishi Cui
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, United States
| | - Stella L Volpe
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, United States
| | - Nathalie S May
- Department of Medicine, College of Medicine, Drexel University, Philadelphia, PA 19102, United States
| | - Deeptha Sukumar
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA 19102, United States
| | - Rose Ann DiMaria-Ghalili
- Department of Graduate Nursing, College of Nursing and Health Professions, Drexel University, Philadelphia, PA 19102, United States
| | - Howard J Eisen
- Division of Cardiology, Heart and Vascular Institute, Pennsylvania State University, Hershey, PA 17033, United States
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Leipe J, Holle JU, Weseloh C, Pfeil A, Krüger K. German Society of Rheumatology recommendations for management of glucocorticoid-induced osteoporosis. Z Rheumatol 2021; 80:49-63. [PMID: 34705070 DOI: 10.1007/s00393-021-01025-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Glucocorticoids are of substantial therapeutic importance in the treatment of inflammatory diseases, but are also associated with bone mineral density loss, osteoporosis, and fractures, especially with long-term use. OBJECTIVE To develop recommendations for the management of glucocorticoid-induced osteoporosis (GIOP) in adult patients on long-term glucocorticoid (GC) treatment. METHODS A systematic literature search (SLR) was conducted to synthesize the evidence for GIOP prevention and treatment options. Recommendations were developed based on SLR/level of evidence and by previously defined questions and in a structured group consensus process. RESULTS Recommendations include supplementation with calcium and vitamin D under long-term GC therapy in adults. If specific osteologic treatment is indicated, we recommend bisphosphonates or denosumab as first-line treatment. If fracture risk is high, we recommend teriparatide as primary specific osteologic treatment. Denosumab should be used in cases of severe renal insufficiency, and specific osteologic treatment should not be given in pregnancy. For patients who have not reached the treatment goal, a switch to another class of specific osteologic drugs should be performed. We recommend re-evaluation after a treatment duration of 3-5 years or after termination of long-term GC treatment. CONCLUSION This work aims to provide evidence-based and consensus-based recommendations for the best possible management of GIOP in Germany and to support treatment decisions.
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Affiliation(s)
- Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany. .,Division of Rheumatology and Clinical Immunology, Medizinische Klinik and Poliklinik IV, University of Munich, Munich, Germany.
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Christiane Weseloh
- German Society of Rheumatology (Deutsche Gesellschaft für Rheumatologie, DGRh), Berlin, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, Munich, Germany
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3
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Leipe J, Holle JU, Weseloh C, Pfeil A, Krüger K. [German Society of Rheumatology Recommendations for the management of glucocorticoid-induced Osteoporosis. German version]. Z Rheumatol 2021; 80:670-687. [PMID: 34357436 DOI: 10.1007/s00393-021-01028-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glucocorticoids are of substantial therapeutic importance in the treatment of inflammatory diseases, but are also associated with bone mineral density loss, osteoporosis, and fractures, especially with long-term use. OBJECTIVE To develop recommendations for the management of glucocorticoid-induced osteoporosis (GIOP) in adult patients on long-term glucocorticoid (GC) treatment. METHODS A systematic literature search (SLR) was conducted to synthesize the evidence for GIOP prevention and treatment options. Recommendations were developed based on SLR/level of evidence and by previously defined questions and in a structured group consensus process. RESULTS Recommendations include supplementation with calcium and vitamin D under long-term GC therapy in adults. If specific osteologic treatment is indicated, we recommend bisphosphonates or denosumab as first-line treatment. If fracture risk is high, we recommend teriparatide as primary specific osteologic treatment. Denosumab should be used in cases of severe renal insufficiency, and specific osteologic treatment should not be given in pregnancy. For patients who have not reached the treatment goal, a switch to another class of specific osteologic drugs should be performed. We recommend re-evaluation after a treatment duration of 3-5 years or after termination of long-term GC treatment. CONCLUSION This work aims to provide evidence-based and consensus-based recommendations for the best possible management of GIOP in Germany and to support treatment decisions.
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Affiliation(s)
- Jan Leipe
- Sektion Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. .,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | | | - Alexander Pfeil
- Klinik für Innere Medizin III, Funktionsbereich Rheumatologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, München, Deutschland
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Concurrent vitamin D supplementation and exercise training improve cardiac fibrosis via TGF-β/Smad signaling in myocardial infarction model of rats. J Physiol Biochem 2021; 77:75-84. [PMID: 33428175 DOI: 10.1007/s13105-020-00778-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/02/2020] [Indexed: 01/02/2023]
Abstract
Although the role of vitamin D in various types of disorders such as cancer and diabetes has been well recognized, its relation to cardiovascular diseases still remains equivocal. The present study aims to investigate the interactive effects of aerobic-resistance training (ART) and vitamin D3 (VD3) on both cardiac fibrosis and heart functions considering TGF-β1/Smad2, 3 (transforming growth factor-β1/mothers against decapentaplegic homolog 2/3) signaling in the myocardial infarction (MI) model of rats. Fifty-six male Wistar rats were divided into 2 groups of sham (n = 8), and MI (n = 48). Then, MI rats were divided into six groups of VD3, ART, VD3+ART, Veh, Veh+ART, and sedentary MI. The animals received the related treatments for 8 weeks, and then their functional exercise capacity (FEC) and strength gain (SG) were estimated through exercise tests. Ejection fraction (EF%) and fractional shortening (FS%) and serum level of VD3 were measured by echocardiography and ELISA, respectively. Cardiac expressions of TGF-β1, Smad2/3, and collagen I/III were assessed by western blotting and fibrosis by Masson's trichrome staining. The highest EF, parallel with the lowest expression of cardiac TGF-β1, Smad2/3, collagen I, and collagen III were observed in MI + VD3 (P = 0.021), MI + ART (P = 0.001), and MI + VD3 + ART (P < 0.001). Furthermore, similar to FS, the highest FEC and SG were related to the groups of MI + VD3 + ART and MI + ART compared to the MI group. In conclusion, our data indicate that concurrent vitamin D supplementation and ART, compared with monotherapy, successfully improve cardiac function and alleviate myocardial fibrosis via downregulating TGF-β1, Smad2/3 signaling, and also regulating collagen I and III expressions.
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Jamali N, Sorenson CM, Sheibani N. Vitamin D and regulation of vascular cell function. Am J Physiol Heart Circ Physiol 2017; 314:H753-H765. [PMID: 29351464 DOI: 10.1152/ajpheart.00319.2017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vitamin D deficiency is linked to pathogenesis of many diseases including cardiovascular, cancer, and various eye diseases. In recent years, important roles for vitamin D in regulation of immune function, inflammation, angiogenesis, and aging have been demonstrated. Thus, vitamin D and its analogs have been evaluated for the treatment of various types of cancer and chronic diseases. We have previously shown that the active form of vitamin D [1,25(OH)2D3] is a potent inhibitor of angiogenesis. This activity is consistent with the important role proposed for vitamin D and its analogs in the mitigation of tumor growth through inhibition of angiogenesis. Here, we review the important nutritional value of vitamin D and the abnormalities linked to its deficiency. We will explore its potential role as a regulator of angiogenesis and vascular cell function and the role vitamin D receptor (VDR) expression plays in these activities during vascular development and neovascularization. Our studies have established an important role for 1,25(OH)2D3 and VDR in the regulation of perivascular supporting cell function. In addition, the interaction of 1,25(OH)2D3 and VDR is essential for these activities and inhibition of neovascularization. Delineating the signaling pathways involved and identification of genes that are the target of 1,25(OH)2D3 regulation in vascular cells will allow us to identify novel pathways that are targets for regulation of vascular function and angiogenesis.
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Affiliation(s)
- Nasim Jamali
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.,McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Christine M Sorenson
- McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Nader Sheibani
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.,McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.,Department of Cell and Regenerative Biology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.,Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
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Rapson IR, Michos ED, Alonso A, Hirsch AT, Matsushita K, Reis JP, Lutsey PL. Serum 25-hydroxyvitamin D is associated with incident peripheral artery disease among white and black adults in the ARIC study cohort. Atherosclerosis 2017; 257:123-129. [PMID: 28131046 PMCID: PMC5369771 DOI: 10.1016/j.atherosclerosis.2017.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/12/2016] [Accepted: 01/13/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Low 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with peripheral artery disease (PAD). Prevalence of low 25(OH)D and PAD differ between whites and blacks. However, these associations have not been studied prospectively or in a population based cohort. We tested the hypothesis that low 25(OH)D is associated with greater risk of incident PAD in white and black adults. METHODS 25(OH)D was measured in serum collected at ARIC visit 2 (1990-1992). We followed 11,789 ARIC participants free of PAD at visit 2 through 2011 for incident PAD events. 25(OH)D (ng/mL) was categorized as deficient (<20), insufficient (20 to <30) or sufficient (≥30). PAD was defined by an ankle brachial index (ABI) of <0.9 at ARIC visits 3 or 4 or a hospital diagnosis with an ICD-9 code indicating PAD during follow-up. Analysis used multivariable-adjusted Cox proportional hazards regressions. RESULTS Over a mean follow-up of 17.1 years, 1250 incident PAD events were identified. 22% of whites and 61% of blacks were 25(OH)D deficient. After adjustment for demographic characteristics, the hazard ratio (95% CI) of PAD in participants with deficient versus sufficient 25(OH)D was 1.49 (1.26, 1.76). Inclusion of BMI, physical activity, and smoking status attenuated the association [1.25 (1.06, 1.48)]. The association between 25(OH)D and PAD was qualitatively stronger in blacks (p for interaction = 0.20). CONCLUSIONS Deficient 25(OH)D was associated with increased risk of PAD in black and white participants. Whether treatment of low vitamin D through supplementation or modest sunlight exposure prevents PAD is unknown.
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Affiliation(s)
- Ian R Rapson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States.
| | - Erin D Michos
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Alan T Hirsch
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kunihiro Matsushita
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD, United States
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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Muñoz-Aguirre P, Denova-Gutiérrez E, Flores M, Salazar-Martínez E, Salmerón J. High Vitamin D Consumption Is Inversely Associated with Cardiovascular Disease Risk in an Urban Mexican Population. PLoS One 2016; 11:e0166869. [PMID: 27893863 PMCID: PMC5125681 DOI: 10.1371/journal.pone.0166869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 11/04/2016] [Indexed: 02/05/2023] Open
Abstract
Background Vitamin D deficiency is a major global public health problem. Recent epidemiological studies have assessed the relationship between vitamin D and multiple outcomes, including cardiovascular disease. However, this evidence is limited and inconclusive. Our purpose in this study was to evaluate the association between dietary vitamin D intake and cardiovascular disease risk in adult Mexican population. Methods We conducted a cross-sectional analysis with the baseline data from 6294 men and women aged 20–80 years participating in the Health Workers Cohort Study. Data on sociodemographic, lifestyle, and medical history factors were collected with a self-administered questionnaire. Dietary intake was evaluated by using a semi-quantitative food-frequency questionnaire. Cardiovascular disease risk was calculated using a recalibration of the Framingham heart disease prediction score. To evaluate the association between vitamin D intake and 10-year cardiovascular disease risk, odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using multiple logistic regression analysis. Results A total of 6294 subjects (1820 men and 4474 women) with a mean age of 42 years, were included. Of these, subjects in the highest quintile of vitamin D intake presented lower levels of triglycerides 14.6 mg/dL (P for trend = 0.001); 2.0 cm less in waist circumference (P for trend = 0.001) and 0.8 points less in the Framingham cardiovascular disease risk score (P for trend = 0.002) compared with the subjects in the lower quintile of vitamin D intake. Additionally, participants in the highest quintile of vitamin D consumption were less likely to develop elevated 10-year cardiovascular disease risk, compared with those in the lowest quintile (OR = 0.51; 95%CI: 0.33, 0.77; P for trend = 0.007). Conclusion Our data suggest that higher consumption of vitamin D is associated with a reduced risk of cardiovascular disease in Mexican population.
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Affiliation(s)
- Paloma Muñoz-Aguirre
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
| | - Edgar Denova-Gutiérrez
- Unidad de Investigación en Epidemiología Clínica, Hospital Infantil de México “Federico Gómez”, Ciudad de México, México
- * E-mail:
| | - Mario Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Eduardo Salazar-Martínez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Abstract
Vitamin D is best known for its influence on skeletal health. There is growing recognition, however, that vitamin D has nonskeletal actions, which could have important implications for understanding the consequences of vitamin D deficiency. In epidemiologic studies, vitamin D deficiency has been consistently associated with an increased risk for cardiovascular disease and hypertension. Disruption of vitamin D signaling in animal models promotes hypertension, cardiac hypertrophy, and atherosclerosis. This evidence has led to the initiation of prospective randomized trials of vitamin D supplementation in individuals at risk for cardiovascular disease. The results of these trials should help to guide strategies for screening and management of vitamin D deficiency in the clinic and at the population level.
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Affiliation(s)
- Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232;
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Schwartz JB, Kane L, Bikle D. Response of Vitamin D Concentration to Vitamin D3 Administration in Older Adults without Sun Exposure: A Randomized Double-Blind Trial. J Am Geriatr Soc 2016; 64:65-72. [PMID: 26782853 DOI: 10.1111/jgs.13774] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the dose-response relationship between 25-hydroxyvitamin D (25(OH)D) and supplemental vitamin D3 in elderly nursing home residents. DESIGN Randomized double-blind investigation. SETTING Nursing home. PARTICIPANTS Of 81 women (n=51) and men (n=30) (mean age 87.4±8) enrolled, 72 completed the study. INTERVENTION Sixteen weeks of oral vitamin D3 at 800, 2,000, or 4,000 IU/d or 50,000 IU/wk. MEASUREMENTS The main outcome was 25(OH)D concentrations (tandem mass spectrometry) after 16 weeks. Free 25(OH)D and intact parathyroid hormone (iPTH) were also analyzed. Safety monitoring of calcium and estimated glomerular filtration rate was performed, and adherence and clinical status were measured. RESULTS 25(OH)D concentrations increased with dose (P<.001) and were higher with 50,000 IU/wk (P<.001) than other doses and with 4,000 IU/d than 800 or 2,000 IU/d, but 800 IU and 2,000 IU/d did not differ. One subject receiving 800 IU/d had concentrations less than 20 ng/mL. All subjects receiving more than 2000 IU/d had concentrations of 20 ng/mL and greater. Free 25(OH)D concentrations rose with total 25(OH) vitamin D. Total and free 25(OH)D were related to calcium concentrations; only free 25(OH)D was related to iPTH. CONCLUSION 25(OH)D increased linearly with 800 to 4,000 IU/d and 50,000 IU/wk of vitamin D3, without a ceiling effect. Data suggest that some elderly adults will require more than 800 IU/d of vitamin D3 to ensure adequate vitamin D levels. Changes in 25(OH)D with vitamin D3 were related to starting concentrations (greatest with the lowest concentrations and unchanged with 800 and 2,000 IU/d if 20-40 ng/mL). Relationships between serum calcium and iPTH and free 25(OH)D suggest the potential for free 25(OH)D in defining optimal 25(OH)D concentrations.
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Affiliation(s)
- Janice B Schwartz
- Jewish Home of San Francisco, San Francisco, California.,Department of Medicine, University of California at San Francisco, San Francisco, California.,Department of Bioengineering and Therapeutic Sciences, University of California at San Francisco, San Francisco, California
| | - Lynn Kane
- Jewish Home of San Francisco, San Francisco, California
| | - Daniel Bikle
- Department of Medicine, University of California at San Francisco, San Francisco, California.,Department of Dermatology, University of California at San Francisco, San Francisco, California
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Nargesi AA, Heidari B, Esteghamati S, Hafezi-Nejad N, Sheikhbahaei S, Pajouhi A, Nakhjavani M, Esteghamati A. Contribution of vitamin D deficiency to the risk of coronary heart disease in subjects with essential hypertension. Atherosclerosis 2015; 244:165-71. [PMID: 26647372 DOI: 10.1016/j.atherosclerosis.2015.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/09/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vitamin D deficiency is proposed as a risk factor for coronary heart disease (CHD). An inverse relation was observed between serum 25-Hydroxy-Vitamin-D level and incidence of hypertension. This study aimed to evaluate the predictive value of serum 25-Hydroxy-Vitamin-D in improvement of CHD risk-stratification in patients with hypertension. METHODS In this cohort, we followed 1586 patients with essential hypertension (1078 diabetic and 508 non-diabetic) for 8.5 years. Physician-adjudicated first hard CHD event was the primary outcome. Cox regression analysis was used to investigate the association between 25-Hydroxy-Vitamin-D quartiles and incident CHD. 25-Hydroxy-Vitamin-D was also added to the Framingham Risk Score (FRS) and Net-Reclassification-Improvement (NRI) and Integrated-Discriminant-Improvement (IDI) were used to examine improved reclassification. RESULTS During follow-up, 176 events were recorded. Patients in the lowest quartile of 25-Hydroxy-Vitamin-D experienced the most number of hard CHD events. A significant linear trend was observed in hazard ratios (HR) of incident hard CHD events in 25-Hydroxy-Vitamin-D quartiles which remained significant after multiple adjustments for conventional CHD risk-factors (HRs in full-adjusted model: 2.87 [1.76-4.70] for 1st quartile, 2.31 [1.39-3.83] for 2nd quartile and 1.87 [1.15-3.03] for 3rd quartile, compared with the highest quartile; p-for-trend<0.001). Addition of 25-Hydroxy-Vitamin-D to FRS could improve CHD risk-estimation (relative-IDI = 15%, p-value<0.001). Addition of 25-Hydroxy-Vitamin-D to FRS successfully reclassified 33% [18-49] of patients with hypertension among CHD risk groups (p-value<0.001). CONCLUSION We observed that serum 25-Hydroxy-Vitamin-D is independently associated with future hard CHD events and improves its prediction in patients with essential hypertension. Addition of serum 25-Hydroxy-Vitamin-D to CHD risk-estimation models may have additive values.
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Affiliation(s)
- Arash Aghajani Nargesi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Behnam Heidari
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sadaf Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sara Sheikhbahaei
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Atieh Pajouhi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Muñoz-Aguirre P, Flores M, Macias N, Quezada AD, Denova-Gutiérrez E, Salmerón J. The effect of vitamin D supplementation on serum lipids in postmenopausal women with diabetes: A randomized controlled trial. Clin Nutr 2014; 34:799-804. [PMID: 25453396 DOI: 10.1016/j.clnu.2014.10.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/26/2014] [Accepted: 10/04/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND & AIMS Dyslipidemia is a risk factor for cardiovascular disease that has become an increasing public health problem. Dyslipidemia is especially relevant in vulnerable populations such as postmenopausal women. Low serum levels of 25-hydroxyvitamin D have been associated with an unfavourable lipid profile. Due to contradictory findings from intervention trials, we investigated the effect of vitamin D supplementation on serum lipids in postmenopausal women with type 2 diabetes. METHODS A total of 104 postmenopausal women with type 2 diabetes were randomly assigned in a double-blind manner to 1 of 2 groups taking a daily tablet for 6 months: a group consuming 4000 IU tablets of a vitamin D supplement (vitamin D group n = 52) or a group consuming placebo tablets (placebo group n = 52). RESULTS The study was completed by 99 participants. However, as the analysis was based on an intention-to-treat approach, all 104 women were included in the final analysis. In the vitamin D group mean serum levels of 25(OH)D3 improved significantly at the end of the follow-up period (+25.5 nmol/L; P = <0.001). Our findings revealed no significant changes in low density lipoproteins, high density lipoproteins and total cholesterol concentrations, but did identify a greater decrease in serum triglycerides in the vitamin D group. The average effect of supplementation on the treated group was -34.24 mg/dL (P = 0.021), while the average treatment effect was -31.8 mg/dL (P = 0.023). CONCLUSIONS Our results suggest that supplementation with vitamin D (4000 IU/d) may have a beneficial effect on serum triglyceride levels without otherwise affecting levels of other lipids. TRIAL REGISTRATION clinicaltrial.gov; identifier NCT01019642.
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Affiliation(s)
| | - Mario Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Nayeli Macias
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
| | - Amado D Quezada
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Edgar Denova-Gutiérrez
- Área Académica de Nutrición, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico; Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico; Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
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12
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Kane L, Moore K, Lütjohann D, Bikle D, Schwartz JB. Vitamin D3 effects on lipids differ in statin and non-statin-treated humans: superiority of free 25-OH D levels in detecting relationships. J Clin Endocrinol Metab 2013; 98:4400-9. [PMID: 24030939 PMCID: PMC3816263 DOI: 10.1210/jc.2013-1922] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Inverse associations between 25-OH vitamin D levels and cardiovascular morbidity and mortality have been reported. OBJECTIVES Our goals were to 1) investigate effects of correcting inadequate D status on lipids, 2) determine whether free 25-OH D is better correlated with lipids than total 25-OH D. DESIGN A randomized, double-blind placebo-controlled trial was performed. SETTING Participants resided in the general community. PARTICIPANTS Adults with inadequate D status were randomized to D3: 14 men, 12 women, age 60 ± 8 years (mean ± SD) or placebo: 12 men, 11 women: 59 ±12 years. INTERVENTION Responses to 12-week oral vitamin D3 titrated (1000-3000 IU/d) to achieve 25-OH D levels ≥25 ng/mL were compared to placebo. MAIN OUTCOME MEASURES Measurements were 25-OH D (tandem mass spectometry), free 25-OH D (direct immunoassay), lipids (directly measured triglyceride, cholesterol, and subfractions; plant sterols and cholesterol synthesis precursors), and safety labs before and after 6 and 12 weeks D3 or placebo. Data were analyzed by repeated measures ANOVA and linear regression. RESULTS Vitamin D3 was titrated to 1000 IU/d in 15/26 (58%), to 2000 IU/d in 10, and 3000 IU/d in one patient. D3 had no effect on cholesterol or cholesterol subfractions except for trends for decreases in atorvastatin-treated patients (cholesterol, P = .08; low-density lipoprotein [LDL] cholesterol, P = .05). Decreased campesterol concentrations (P = .05) were seen with D3 but not placebo in statin-treated patients. Relationships between total 25-OH D and lipids were not detected, but inverse linear relationships were detected between free 25-OH D and triglycerides (P = .03 for all participants [n = 49], P = .03 in all statin-treated [n = 19], and P = .0009 in atorvastatin-treated [n = 11]), and between free 25-OH D and LDL cholesterol (P = .08 overall, P = .02 in all statin-treated, and P = .03 for atorvastatin-treated), and total cholesterol (P = .09 overall; P = .04 for all statin-treated, and P = .05 for atorvastatin-treated). CONCLUSIONS Vitamin D lipid-lowering effects appear limited to statin-treated patients and are likely due to decreased cholesterol absorption. Relationships between lipids and D metabolites were only detected when free 25-OH D was measured, suggesting the superiority of determining free 25-OH D levels compared to total 25-OH vitamin D levels when analyzing biologic responses.
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Affiliation(s)
- Lynn Kane
- MD, 302 Silver Avenue, San Francisco, CA 94112.
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13
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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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Is Endothelial Nitric Oxide Synthase a Moonlighting Protein Whose Day Job is Cholesterol Sulfate Synthesis? Implications for Cholesterol Transport, Diabetes and Cardiovascular Disease. ENTROPY 2012. [DOI: 10.3390/e14122492] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Fung GJ, Steffen LM, Zhou X, Harnack L, Tang W, Lutsey PL, Loria CM, Reis JP, Van Horn LV. Vitamin D intake is inversely related to risk of developing metabolic syndrome in African American and white men and women over 20 y: the Coronary Artery Risk Development in Young Adults study. Am J Clin Nutr 2012; 96:24-9. [PMID: 22648727 PMCID: PMC3374731 DOI: 10.3945/ajcn.112.036863] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vitamin D intake may play a key role in the prevention of cardiovascular disease. OBJECTIVE We evaluated associations of dietary and supplemental vitamin D intake with the 20-y incidence of metabolic syndrome. DESIGN Data from 4727 black and white young men and women from the Coronary Artery Risk Development in Young Adults study were used to examine relations of dietary plus supplemental vitamin D intake with the incidence of metabolic syndrome (as defined by Adult Treatment Panel, third report, guidelines) and the prevalence of its components, including abdominal obesity, elevated blood pressure, and high glucose, low HDL, and high triglyceride concentrations. RESULTS The intake of vitamin D from dietary and supplemental sources was inversely related to the 20-y cumulative prevalence of abdominal obesity (P = 0.05) and high glucose (P = 0.02) and low HDL (P = 0.004) concentrations after adjustment for age, sex, race, education, center, and energy intake. In comparison with the lowest intake quintile (quintile 1), HRs (95% CIs) of developing incident metabolic syndrome for quintiles 2-5 of vitamin D intake were 0.82 (0.67, 1.00), 0.84 (0.68, 1.03), 0.70 (0.56, 0.88), and 0.82 (95% CI: 0.65, 1.02), respectively (P-trend = 0.03) after adjustment for demographic and lifestyle factors. CONCLUSIONS In young adults, the dietary plus supplemental vitamin D intake was inversely related to the development of incident metabolic syndrome over 20 y of follow-up. These findings support the recommendations of the Dietary Guidelines for Americans to increase intakes of vitamin D-rich foods, such as milk and fish.
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Affiliation(s)
- Grace J Fung
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA
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16
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Muscogiuri G, Sorice GP, Ajjan R, Mezza T, Pilz S, Prioletta A, Scragg R, Volpe SL, Witham MD, Giaccari A. Can vitamin D deficiency cause diabetes and cardiovascular diseases? Present evidence and future perspectives. Nutr Metab Cardiovasc Dis 2012; 22:81-87. [PMID: 22265795 DOI: 10.1016/j.numecd.2011.11.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 10/04/2011] [Accepted: 11/02/2011] [Indexed: 01/13/2023]
Abstract
Several studies have shown that vitamin D may play a role in many biochemical mechanisms in addition to bone and calcium metabolism. Recently, vitamin D has sparked widespread interest because of its involvement in the homeostasis of the cardiovascular system. Hypovitaminosis D has been associated with obesity, related to trapping in adipose tissue due to its lipophilic structure. In addition, vitamin D deficiency is associated with increased risk of cardiovascular disease (CVD) and this may be due to the relationship between low vitamin D levels and obesity, diabetes mellitus, dyslipidaemia, endothelial dysfunction and hypertension. However, although vitamin D has been identified as a potentially important marker of CVD, the mechanisms through which it might modulate cardiovascular risk are not fully understood. Given this background, in this work we summarise clinical retrospective and prospective observational studies linking vitamin D levels with cardio-metabolic risk factors and vascular outcome. Moreover, we review various randomised controlled trials (RCTs) investigating the effects of vitamin D supplementation on surrogate markers of cardiovascular risk. Considering the high prevalence of hypovitaminosis D among patients with high cardiovascular risk, vitamin D replacement therapy in this population may be warranted; however, further RCTs are urgently needed to establish when to begin vitamin D therapy, as well as to determine the dose and route and duration of administration.
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Affiliation(s)
- G Muscogiuri
- Endocrinologia e Malattie del Metabolismo, Università Cattolica, Rome, Italy.
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Vitamin D and public health: an overview of recent research on common diseases and mortality in adulthood. Public Health Nutr 2011; 14:1515-32. [PMID: 21729467 DOI: 10.1017/s1368980011001455] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE There is increasing interest in vitamin D and its possible health effects. The aims of the present overview are to summarise the research on common diseases for which there is substantial evidence on vitamin D, identify diseases where vitamin D may be beneficial and discuss the public health implications of these findings. DESIGN Literature search of PubMed for the years 2000 to 2010 to identify cohort studies with baseline measures of 25-hydroxyvitamin D (25(OH)D) and randomised controlled trials (RCT) of vitamin D supplementation in relation to fractures, colorectal cancer, CVD and all-cause mortality. Risk ratios of disease from comparisons between 25(OH)D quantiles in these studies were summarised using RevMan software version 5·1 (The Nordic Cochrane Centre, Copenhagen). SETTING Community-based samples recruited into cohort studies from many countries. SUBJECTS Older men and women, mostly above 50 years of age. RESULTS When comparing the lowest 25(OH)D category with the highest (or reference), the pooled risk ratio (95 % CI) was: 1·34 (1·13, 1·59) for fractures from nine studies; 1·59 (1·30, 1·95) for colorectal cancer from nine studies; 1·35 (1·17, 1·56) for CVD from twelve studies; and 1·42 (1·23, 1·63) for all-cause mortality from twelve studies. CONCLUSIONS Cohort studies show that baseline 25(OH)D levels predict increased risk of fractures, colorectal cancer, CVD and all-cause mortality. These associations are weak and could be explained by confounding variables such as obesity and physical activity. Because of their potential public health significance, RCT using vitamin D doses ≥50 μg/d are required to determine whether vitamin D protects against these diseases.
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Thadhani R, Manson JE. Vitamin D for Cardiovascular Disease Prevention in Women: State of the Evidence. CURRENT CARDIOVASCULAR RISK REPORTS 2010. [DOI: 10.1007/s12170-010-0098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Rajpathak SN, Xue X, Wassertheil-Smoller S, Van Horn L, Robinson JG, Liu S, Allison M, Martin LW, Ho GYF, Rohan TE. Effect of 5 y of calcium plus vitamin D supplementation on change in circulating lipids: results from the Women's Health Initiative. Am J Clin Nutr 2010; 91:894-9. [PMID: 20181812 PMCID: PMC2844677 DOI: 10.3945/ajcn.2009.28579] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dietary calcium and vitamin D intakes may be inversely associated with cardiovascular disease (CVD) risk, possibly because of their potential beneficial effects on circulating lipids. Clinical trials that have evaluated the effect of calcium supplementation on lipids are limited by a short follow-up, and data on vitamin D are scarce. OBJECTIVE The objective was to evaluate the effect of a longer-term effect (over 5 y) of calcium and vitamin D (CaD) supplementation on changes in the concentrations of several lipids: LDL, HDL, non-HDL, total cholesterol, triglycerides, and lipoprotein(a) [Lp(a)]. DESIGN The study was conducted in 1259 postmenopausal women in the Calcium plus Vitamin D Trial (1 g elemental Ca as carbonate plus 400 IU vitamin D(3)/d compared with placebo) of the Women's Health Initiative. Analyses were conducted by intention-to-treat. Repeated measurements on lipids during follow-up were analyzed by linear mixed-effects models. RESULTS Overall, the change in lipids was relatively small [< or =5% except for Lp(a), which was 20-25%], and there was no significant difference in the mean change of any lipid variable between the active and placebo groups. CONCLUSIONS Our results indicate that CaD supplementation is not associated with lipid changes over 5 y. Existing and future CaD trials should consider evaluating this association for different doses of supplements. This study was registered at clinicaltrials.gov as NCT00000611.
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Affiliation(s)
- Swapnil N Rajpathak
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
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Abstract
Results from ecological, case-control and cohort studies have shown that vitamin D reduces the risk of bone fracture, falls, autoimmune diseases, type 2 diabetes, CVD and cancer. However, there is still epidemic vitamin D insufficiency especially among individuals living at high latitudes or with dark skin. Serum levels of 25-hydroxyvitamin D (25(OH)D) are considered the best biomarker of vitamin D nutritional status. Appropriate sunshine exposure or oral supplementation is necessary to maintain sufficient vitamin D status, which is generally accepted as serum 25(OH)D>75 nmol/l. Immunoassays, especially RIA, have been primarily used to measure serum 25(OH)D while liquid chromatography-MS (LC-MS) is considered the 'gold standard'. There is significant disparity among the immunoassays, and all immunoassays have considerable bias compared with LC-MS methods. Because of the variations among the results from these different assays, it is necessary that assay-specific reference ranges be established or standardisation of the assays take place. The present review focuses on ecological, case-control, and cohort studies that investigated the role of vitamin D in health and disease. In addition, analytical techniques used in laboratory evaluation of vitamin D nutritional status are also critically reviewed. The majority of the literature included in the present review is selected from that searchable in PubMed up to the end of September 2008.
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21
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Ginde AA, Scragg R, Schwartz RS, Camargo CA. Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults. J Am Geriatr Soc 2009; 57:1595-603. [DOI: 10.1111/j.1532-5415.2009.02359.x] [Citation(s) in RCA: 275] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Michos ED, Streeten EA, Ryan KA, Rampersaud E, Peyser PA, Bielak LF, Shuldiner AR, Mitchell BD, Post W. Serum 25-hydroxyvitamin d levels are not associated with subclinical vascular disease or C-reactive protein in the old order amish. Calcif Tissue Int 2009; 84:195-202. [PMID: 19148561 PMCID: PMC2908302 DOI: 10.1007/s00223-008-9209-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/02/2008] [Indexed: 12/24/2022]
Abstract
The relationship between vitamin D metabolites and subclinical vascular disease is controversial. Because low serum levels of 25-hydroxyvitamin D (25(OH)D) have been associated with many cardiovascular disease (CVD) risk factors, we hypothesized that serum 25(OH)D levels would be inversely associated with inflammation as measured by C-reactive protein (CRP) and with subclinical vascular disease as measured by carotid intimal medial thickness (cIMT) and coronary artery calcification (CAC). We measured 25(OH)D levels in 650 Amish participants. CAC was measured by computed tomography and cIMT by ultrasound. The associations of 25(OH)D levels with natural log(CAC + 1), cIMT, and natural log(CRP) levels were estimated after adjustment for age, sex, family structure, and season of examination. Additional analyses were carried out adjusting for body mass index (BMI) and other CVD risk factors. 25(OH)D deficiency (<20 ng/ml) and insufficiency (21-30 ng/ml) were common among the Amish (38.2% and 47.7%, respectively). 25(OH)D levels were associated with season, age, BMI, and parathyroid hormone levels. In neither the minimally or fully adjusted analyses were significant correlations observed between 25(OH)D levels and CAC, cIMT, or CRP (R (2) < 0.01 for all). Contrary to our hypothesis, this study failed to detect a cross-sectional association between serum 25(OH)D levels and CAC, cIMT, or CRP. Either there is no causal relationship between 25(OH)D and CVD risk, or if there is, it may be mediated through mechanisms other than subclinical vascular disease severity.
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Affiliation(s)
- Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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23
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Reis JP, Michos ED, von Mühlen D, Miller ER. Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease. Am J Clin Nutr 2008; 88:1469-77. [PMID: 19064505 DOI: 10.3945/ajcn.2008.26447] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Racial differences in cardiovascular risk factors do not fully explain the higher prevalence of lower-extremity peripheral arterial disease (PAD) in black adults. OBJECTIVE We sought to determine whether any of this excess risk may be explained by vitamin D status, which has been widely documented to be lower in blacks than in whites. DESIGN This population-based cross-sectional study included 2987 white and 866 black persons aged >or=40 y from the 2001-2004 National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial pressure index of <0.90 in either leg. RESULTS Mean (+/-SEM) 25-hydroxyvitamin D [25(OH)D] concentrations were significantly lower in black than in white adults (39.2 +/- 1.0 and 63.7 +/- 1.1 nmol/L, respectively; P < 0.001). Adjusted odds ratios for PAD decreased in a dose-dependent fashion with increasing quartiles of 25(OH)D in white adults [1.00 (referent), 0.86, 0.67, and 0.53; P for trend < 0.001]. In black adults, the association was nonlinear; models with cubic splines suggested evidence of greater odds for PAD and a trend for lower odds for PAD at the lowest and highest concentrations of 25(OH)D, respectively. After adjustment for racial differences in socioeconomic status and for traditional and novel risk factors, odds for PAD in black compared with white adults were reduced from 2.11 (95% CI: 1.55, 2.87) to 1.67 (1.11, 2.51). After additional adjustment for 25(OH)D, the odds were further reduced to 1.33 (0.84, 2.10). CONCLUSIONS Racial differences in vitamin D status may explain nearly one-third of the excess risk of PAD in black compared with white adults. Additional research is needed to confirm these findings.
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Affiliation(s)
- Jared P Reis
- Welch Center for Prevention, Epidemiology, and Clinical Research and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA.
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Lichtenstein AH. Nutrient supplements and cardiovascular disease: a heartbreaking story. J Lipid Res 2008; 50 Suppl:S429-33. [PMID: 18997166 DOI: 10.1194/jlr.r800027-jlr200] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Observational data have identified associations between carotenoids, folic acid, and vitamin E, or metabolites altered by these nutrients, and cardiovascular disease (CVD) risk. Despite biological plausibility, for the most part, data derived from nutrient supplement trials using moderate to high doses of single nutrients or nutrient combinations (exceeding amounts to avoid nutrient deficiency) have been disappointing. The data for vitamin D is not yet adequate to evaluate; observational data suggest were a relationship to exist it would be related to nutrient insufficiency. There is some evidence that use of nutrient supplements intended to decrease CVD risk has resulted in unanticipated adverse consequences. Potential discrepancies between observational and interventional data include concerns of residual confounding by diet and lifestyle patterns, publication bias against studies with null or negative outcomes, reliance on secondary rather than primary prevention trials, and unaccounted for contribution of genotypic variations. At this time there are insufficient data to recommend the routine use of nutrient supplements to prevent or treat CVD. In the recent past we have learned a great deal about anticipated and unanticipated consequences of nutrient supplementation and cardiovascular outcomes. As a result, we are in a better position to adjudicate new potential relationships as data emerge.
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Affiliation(s)
- Alice H Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University, Boston MA 02111, USA.
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Andrade J, Er L, Ignaszewski A, Levin A. Exploration of association of 1,25-OH2D3 with augmentation index, a composite measure of arterial stiffness. Clin J Am Soc Nephrol 2008; 3:1800-6. [PMID: 18922995 DOI: 10.2215/cjn.00900208] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Abnormalities in mineral metabolism [calcium, phosphate, and immunoreactive parathyroid hormone (PTH)] and vitamin D have been linked to increases in central arterial stiffness. Central arterial stiffness can be measured using noninvasive technologies, including augmentation index (AIx), a composite measure of arterial stiffness. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS In 131 outpatients identified from individual cardiac or kidney disease clinics, we examined conventional demographic and laboratory risk factors, vitamin D levels (1,25-OH2D3 and 25-OHD3), and markers of inflammation or endothelial function [C-reactive peptide (hsCRP), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), and IL-6] in relationship to AIx. RESULTS The median eGFR was significantly different between clinics (range 25-81 ml/min). Subjects with higher phosphate or MMP-9 levels were found to have a higher AIx (P = 0.02 and 0.07, respectively). Lower 1,25-OH2D3 levels or reduced eGFR were associated with higher AIx (P = 0.002 and 0.005, respectively). The associations between 1,25-OH2D3 and phosphate levels and AIx were observed for values within the normal range. No association was noted for calcium, iPTH, 25-OHD3, or hsCRP and AIx. Adjusting for potential confounders [eGFR, calcium, phosphate, and (log) iPTH] the association of lower 1,25-OH2D3 with AIx remained statistically significant. CONCLUSION This exploratory study demonstrates a significant association between AIx and 1,25-OH2D3 in a diverse group with cardiac, kidney disease, or both. These increasing understanding of the role of vitamin D in vascular health lends a context to these findings and raises questions as to additional modifiable risk factors in complex patients. Further studies are required.
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Affiliation(s)
- Jason Andrade
- Department of Medicine, University of British Columbia, Saint Paul's Hospital, Vancouver, BC, Canada
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Godfrey JR, Manson JE. Toward Optimal Health: Strategies for Prevention of Heart Disease in Women. J Womens Health (Larchmt) 2008; 17:1271-6. [DOI: 10.1089/jwh.2008.1074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Vitamin D is known for its role in calcium homeostasis for optimal skeletal health. It was previously believed that only elderly or hospitalized patients were at risk for vitamin D insufficiency, but many people in the general US population have insufficient levels of 25-hydroxyvitamin D (25D). According to the Third National Health and Nutrition Examination Survey, 61% of white and 91% of black Americans suffer from vitamin D insufficiency (25D < 32 ng/mL). Recent studies have demonstrated that a minimum 25(OH)D level of 32 ng/mL is necessary for optimal protection from fracture and intestinal absorption of calcium. Recently, vitamin D has been recognized as important for extraskeletal functions such as immune function, cancer prevention, and hypertension prevention. We review the role of vitamin D in skeletal health and present data on vitamin D in other extraskeletal diseases, with special emphasis on the rheumatology patient.
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Affiliation(s)
- Natasha Khazai
- Woodruff Memorial Research Building, Room 1301, 101 Woodruff Circle Northeast, Atlanta, GA 30322, USA
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Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, Benjamin EJ, D'Agostino RB, Wolf M, Vasan RS. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117:503-11. [PMID: 18180395 DOI: 10.1161/circulationaha.107.706127] [Citation(s) in RCA: 1612] [Impact Index Per Article: 100.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin D receptors have a broad tissue distribution that includes vascular smooth muscle, endothelium, and cardiomyocytes. A growing body of evidence suggests that vitamin D deficiency may adversely affect the cardiovascular system, but data from longitudinal studies are lacking. METHODS AND RESULTS We studied 1739 Framingham Offspring Study participants (mean age 59 years; 55% women; all white) without prior cardiovascular disease. Vitamin D status was assessed by measuring 25-dihydroxyvitamin D (25-OH D) levels. Prespecified thresholds were used to characterize varying degrees of 25-OH D deficiency (< 15 ng/mL, < 10 ng/mL). Multivariable Cox regression models were adjusted for conventional risk factors. Overall, 28% of individuals had levels < 15 ng/mL, and 9% had levels < 10 ng/mL. During a mean follow-up of 5.4 years, 120 individuals developed a first cardiovascular event. Individuals with 25-OH D < 15 ng/mL had a multivariable-adjusted hazard ratio of 1.62 (95% confidence interval 1.11 to 2.36, P=0.01) for incident cardiovascular events compared with those with 25-OH D > or = 15 ng/mL. This effect was evident in participants with hypertension (hazard ratio 2.13, 95% confidence interval 1.30 to 3.48) but not in those without hypertension (hazard ratio 1.04, 95% confidence interval 0.55 to 1.96). There was a graded increase in cardiovascular risk across categories of 25-OH D, with multivariable-adjusted hazard ratios of 1.53 (95% confidence interval 1.00 to 2.36) for levels 10 to < 15 ng/mL and 1.80 (95% confidence interval 1.05 to 3.08) for levels < 10 ng/mL (P for linear trend=0.01). Further adjustment for C-reactive protein, physical activity, or vitamin use did not affect the findings. CONCLUSIONS Vitamin D deficiency is associated with incident cardiovascular disease. Further clinical and experimental studies may be warranted to determine whether correction of vitamin D deficiency could contribute to the prevention of cardiovascular disease.
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Abstract
PURPOSE OF REVIEW Despite our understanding of how to prevent and treat traditional cardiovascular risk factors, cardiovascular disease remains the leading cause of death of both men and women in the US. Thus, there is widespread interest in a number of emerging nontraditional risk factors for the detection of early cardiovascular disease in order to implement aggressive preventive therapies. 25-Hydroxyvitamin D deficiency has been identified as a potential novel cardiovascular disease risk factor. This review outlines what is known about the association of 25-hydroxyvitamin D levels and cardiovascular disease risk. RECENT FINDINGS Low 25-hydroxyvitamin D levels have been associated with the cardiovascular disease risk factors of hypertension, obesity, diabetes mellitus and the metabolic syndrome, as well as cardiovascular disease events including stroke and congestive heart failure. Studies suggest vitamin D deficiency may be a contributor to the development of cardiovascular disease potentially through associations with diabetes or hypertension. SUMMARY Vitamin D deficiency is easy to screen for and easy to treat with supplementation. Further larger observational studies and randomized clinical trials are, however, needed to determine whether vitamin D supplementation could have any potential benefit in reducing future cardiovascular disease events and mortality risk.
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Affiliation(s)
- Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
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Abstract
The major cardiovascular diseases affecting the developed world have at their core atherosclerosis and hypertension, both of which are profoundly affected by diet and can be approached, at least in part, from a nutritional point of view, as can the increasing “epidemic” of obesity. Diet is a multi-component mixture of many nutrients, which may interact with one another. The definitive study of nutrients and their impact on cardiovascular disease can be a daunting enterprise. Many dietary risk factors contribute to these diseases in various environmental and ethnic settings. These risk factors are often in evidence in youth so that preventive measures must be initiated early in life. Although most of the information about nutritional risk factors and cardiovascular disease derives from studies in the developed world, the situation is rapidly evolving toward epidemic proportions in the developing world where a major burden on the economy and health services will be imposed.
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Affiliation(s)
- Godfrey S. Getz
- From the Department of Pathology, The University of Chicago, Ill
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