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Vitamin D and cardiovascular disease: update and outlook
Stefan Pilz1, Katharina Kienreich, Andreas Tomaschitz
1Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria. stefan.pilz@chello.at
Insights
Vitamin D may influence cardiovascular health, with deficiency linked to increased cardiovascular disease (CVD) risk. However, current evidence is insufficient for recommending vitamin D supplementation to prevent or treat CVD.
Area of Science:
- Cardiology
- Endocrinology
- Nutritional Science
Background:
- Vitamin D receptor (VDR) and metabolism enzymes are present in the heart and vasculature.
- VDR knockout mice and selective VDR deletion in cardiomyocytes exhibit cardiovascular disease and myocardial hypertrophy.
- Observational studies frequently link vitamin D deficiency to cardiovascular disease (CVD) and its risk factors.
Purpose of the Study:
- To review the current evidence on the role of vitamin D in cardiovascular health.
- To assess the association between vitamin D status and cardiovascular events.
- To evaluate the efficacy of vitamin D supplementation for cardiovascular disease prevention and treatment.
Main Methods:
- Review of observational studies and randomized controlled trials (RCTs) concerning vitamin D and cardiovascular health.
- Analysis of studies investigating the impact of vitamin D deficiency and supplementation on cardiovascular risk factors and events.
- Consideration of limitations in existing RCT designs, including calcium co-supplementation and participant 25-hydroxyvitamin D (25(OH)D) levels.
Main Results:
- Low 25-hydroxyvitamin D (25(OH)D) concentrations are an independent risk factor for cardiovascular events, including strokes and sudden cardiac deaths.
- RCTs with vitamin D and calcium supplementation have shown mixed results, with potential increased CVD risk.
- RCTs with pure vitamin D supplementation have inconsistently demonstrated benefits for cardiovascular risk factors like hypertension.
Conclusions:
- Current evidence is insufficient to recommend general vitamin D supplementation for CVD prevention or treatment.
- Further large-scale RCTs are needed, carefully considering study design limitations.
- Vitamin D supplementation is justified for musculoskeletal health, which may indirectly benefit cardiovascular health.
Abstract:
Accumulating evidence suggests that vitamin D may play a role for cardiovascular health. Expression of the vitamin D receptor (VDR) and enzymes for vitamin D metabolism have been identified in the vasculature as well as in the heart. VDR knock-out mice suffer from cardiovascular disease (CVD) and even selective VDR deletion in cardiomyocytes causes myocardial hypertrophy. Many, but not all observational studies showed that vitamin D deficiency is associated with CVD and its risk factors. Low concentrations of 25-hydroxyvitamin D (25(OH)D) are an independent risk factor for cardiovascular events, in particular for strokes and sudden cardiac deaths. Only few randomized controlled trials (RCTs) are available on this topic. These RCTs are frequently limited by the additional supplementation of calcium which may increase the risk of CVD events. RCTs with pure vitamin D supplementation have partially but not consistently shown beneficial effects on cardiovascular risk factors such as arterial hypertension. A number of large RCTs on the impact of vitamin D supplementation on cardiovascular events and mortality have already started but limitations of the study designs such as inclusion of individuals with relatively high 25(OH)D concentrations have to be considered. At present, the evidence is not sufficient for general recommendations to supplement vitamin D in order to prevent and treat CVD. It should, however, be noted that justification for the prevention and treatment of vitamin D deficiency comes from evidence based benefits of vitamin D supplementation on musculoskeletal health.
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