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Vitamin D Supplementation and Its Impact on Mortality and Cardiovascular Outcomes: Systematic Review and
Antonio Ruiz-García1,2, Vicente Pallarés-Carratalá3,4, Miguel Turégano-Yedro5
1Lipids and Cardiovascular Prevention Unit, Pinto University Health Center, 28320 Madrid, Spain.
Background:
The impact of vitamin D supplementation on cardiovascular outcomes and mortality risk reduction remains unclear due to conflicting study findings.
Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between 1983 and 2022, that reported the effect of vitamin D supplementation in adults versus placebo or no treatment on all-cause mortality (ACM), cardiovascular mortality (CVM), non-cardiovascular mortality (non-CVM), and cardiovascular morbidities. Only studies with a follow-up period longer than one year were included. The primary outcomes were ACM and CVM. Secondary outcomes were non-CVM, myocardial infarction, stroke, heart failure, and major or extended adverse cardiovascular events. Subgroup analyses were performed according to low-, fair- and good-quality RCTs.
Results:
Eighty RCTs were assessed, including 82,210 participants receiving vitamin D supplementation and 80,921 receiving placebo or no treatment. The participants' mean (SD) age was 66.1 (11.2) years, and 68.6% were female. Vitamin D supplementation was associated with a lower risk of ACM (OR: 0.95 [95%CI 0.91-0.99] p = 0.013), was close to statistical significance for a lower risk of non-CVM (OR: 0.94 [95%CI 0.87-1.00] p = 0.055), and was not statistically associated with a lower risk of any cardiovascular morbi-mortality outcome. Meta-analysis of low-quality RCTs showed no association with cardiovascular or non-cardiovascular morbi-mortality outcomes.
Conclusions:
The emerging results of our meta-analysis present evidence that vitamin D supplementation appears to decrease the risk of ACM (especially convincing in the fair- and good-quality RCTs), while not showing a decrease in the specific cardiovascular morbidity and mortality risk. Thus, we conclude that further research is warranted in this area, with well-planned and executed studies as the basis for more robust recommendations.
Insights
Vitamin D supplementation may reduce all-cause mortality risk, particularly in higher-quality trials. However, it did not significantly impact cardiovascular mortality or morbidity outcomes in this meta-analysis.
Area of Science:
- Nutritional Science
- Cardiovascular Health
- Public Health
Background:
- Conflicting evidence exists regarding vitamin D supplementation's effects on cardiovascular outcomes and mortality.
- The precise impact of vitamin D on reducing mortality risk requires further clarification.
Approach:
- A systematic review and meta-analysis of 80 randomized controlled trials (RCTs) involving over 160,000 participants was conducted.
- Studies published between 1983 and 2022 with follow-up exceeding one year were included.
- Analysis focused on all-cause mortality, cardiovascular mortality, and various cardiovascular morbidities, with subgroup analyses based on RCT quality.
Key Points:
- Vitamin D supplementation was associated with a statistically significant reduction in all-cause mortality (OR: 0.95, p=0.013).
- A trend towards reduced non-cardiovascular mortality was observed (OR: 0.94, p=0.055).
- No significant association was found between vitamin D supplementation and cardiovascular mortality or morbidity outcomes. Low-quality RCTs showed no association with mortality outcomes.
Conclusions:
- Vitamin D supplementation appears to decrease the risk of all-cause mortality, with stronger evidence from fair- and good-quality RCTs.
- The supplementation did not demonstrate a significant decrease in specific cardiovascular morbidity and mortality risks.
- Further well-designed research is necessary to establish robust recommendations regarding vitamin D supplementation for cardiovascular health.
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