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Scragg R. Clinical trials of vitamin D supplementation and cardiovascular disease: A synthesis of the evidence. J Steroid Biochem Mol Biol 2025; 250:106733. [PMID: 40096916 DOI: 10.1016/j.jsbmb.2025.106733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 03/04/2025] [Accepted: 03/12/2025] [Indexed: 03/19/2025]
Abstract
The evidence linking vitamin D deficiency with increased risk of cardiovascular disease (CVD) extends back to 1970s when case control studies showed lower circulating concentrations of 25-hydroxyvitamin D [25(OH)D] in myocardial infarction cases compared with controls, which was strengthened by the identification of a vitamin D receptor in cardiac muscle in 1980s. Cohort studies published in the 2000s provided stronger evidence (by measuring 25(OH)D concentrations before the onset of CVD) and confirmed the inverse association between circulating 25(OH)D concentrations and CVD risk. However, concerns remained about possible residual confounding as the reason for the inverse association. This stimulated the initiation of several large scale randomized controlled trials (RCTs) of vitamin D supplementation with CVD as a pre-specified outcome. Results from these studies have been combined with findings from earlier RCTs in a recent meta-analysis undertaken on behalf of the US Endocrine Society. In 14 RCTs with 80,547 participants aged 50-74 years, vitamin D supplementation did not protect against CVD when compared to placebo: risk ratio 1.00 (95 % confidence interval 0.93-1.08). This result did not vary by study quality (risk of bias), gender, calcium co-administration, vitamin D dose or trial setting (community or residential care). This finding is consistent with recent mendelian randomization studies which have not detected a beneficial effect associated with genetically predicted 25(OH)D in people with vitamin D deficiency. Overall, the current evidence indicates that vitamin D does not prevent CVD.
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Affiliation(s)
- Robert Scragg
- School of Population Health, The University of Auckland, Auckland, New Zealand.
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Baig M, Alghalayini KW, Gazzaz ZJ, Murad MA. Serum Vitamin D and Vaspin Levels Among Patients with Acute Myocardial Infarction and Their Association with Risk Factors. Int J Gen Med 2024; 17:2907-2917. [PMID: 38974138 PMCID: PMC11227333 DOI: 10.2147/ijgm.s466665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose The current study investigated and compared serum levels of vitamin D (VD) and vaspin in AMI patients and healthy subjects and correlated these biomarkers with other biochemical risk factors for AMI. Patients and Methods The research was carried out at King Abdulaziz University Hospital (KAUH) in Jeddah. Blood samples and additional information were gathered from 110 admitted AMI patients in the Intensive Coronary Care Unit (ICCU) (ages 40-65 years) and 50 adult, healthy volunteers whose BMI and age were similar to those of the patients. Results AMI patients had significantly lower vaspin (p < 0.001) and VD levels (p < 0.001) than the control group. Fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were shown to be significantly different between AMI patients and controls. Among the AMI patients, 15 (13.6%) had deficient serum VD levels (≤20 ng/mL), 60 (54.5%) had insufficient levels (>20 - <30 ng/mL), and 35 (31.8%) had sufficient levels (≥30 ng/mL). In healthy subjects, VD levels were deficient in 4(8%), insufficient in 13 (26%), and sufficient in 33 (66%). VD insufficiency was more prevalent in AMI patients compared to the healthy group (54.5% vs 26%; p < 0.001). In AMI patients, serum vaspin was found to be related to age and HbA1c in the control group. VD did not show a significant correlation with any variable in AMI patients and healthy subjects. Serum vaspin (p = 0.89) and VD levels (p = 0.29) did not differ significantly between female and male control groups. Conclusion Compared to the healthy group, AMI patients showed significantly lower vaspin and VD levels. Additionally, AMI patients had a higher prevalence of VD deficiency and insufficiency, suggesting its possible role in the occurrence of AMI.
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Affiliation(s)
- Mukhtiar Baig
- Department of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kamal Waheeb Alghalayini
- Department of Internal Medicine, Consultant Cardiologist, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Zohair Jamil Gazzaz
- Department of Internal Medicine, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Manal Abdulaziz Murad
- Department of Family and Community Medicine, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
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Haider F, Ghafoor H, Hassan OF, Farooqui K, Bel Khair AOM, Shoaib F. Vitamin D and Cardiovascular Diseases: An Update. Cureus 2023; 15:e49734. [PMID: 38161941 PMCID: PMC10757591 DOI: 10.7759/cureus.49734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Vitamin D is a vital nutrient that plays a significant part in several physiological processes within the human body, including calcium metabolism, bone health, immune function, and cell growth and differentiation. It is obtained mainly through exposure to sunlight but can be acquired from certain foods and supplements as well. Vitamin D deficiency (VDD) could be the risk factor for cardiovascular diseases (CVDs), such as heart disease and stroke. In blood vitamin D low levels have been linked with an enhanced risk of developing CVDs. However, it is unclear whether vitamin D levels are the leading cause or consequence of these conditions. While some studies highlight that taking vitamin D supplements could decrease the risk of CVD; however, more research is required to better understand the association between vitamin D and cardiovascular health. In this review, we aimed to summarize the currently available evidence supporting the association between vitamin D and CVDs and anesthesia considerations.
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Affiliation(s)
- Farrookh Haider
- Department of Internal Medicine, Section of Cardiology Al Khor Hospital, Hamad Medical Corporation, Al Khor, QAT
- Department of Internal Medicine, College of Medicine/Qatar University, Doha, QAT
| | - Hashsaam Ghafoor
- Department of Anesthesia, Al Khor Hospital, Hamad Medical Corporation, Al Khor, QAT
- Department of Anesthesiology, Qatar University, Doha, QAT
| | - Omar F Hassan
- Department of Internal Medicine, Section of Cardiology Al Khor Hospital, Hamad Medical Corporation, Al Khor, QAT
| | - Khalid Farooqui
- Department of Internal Medicine, Al Khor Hospital, Hamad Medical Corporation, Al Khor, QAT
| | | | - Faryal Shoaib
- Department of Internal Medicine, Shifa International Hospitals, Islamabad, PAK
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Cosentino N, Campodonico J, Milazzo V, De Metrio M, Brambilla M, Camera M, Marenzi G. Vitamin D and Cardiovascular Disease: Current Evidence and Future Perspectives. Nutrients 2021; 13:nu13103603. [PMID: 34684604 PMCID: PMC8541123 DOI: 10.3390/nu13103603] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Vitamin D deficiency is a prevalent condition, occurring in about 30–50% of the population, observed across all ethnicities and among all age groups. Besides the established role of vitamin D in calcium homeostasis, its deficiency is emerging as a new risk factor for cardiovascular disease (CVD). In particular, several epidemiological and clinical studies have reported a close association between low vitamin D levels and major CVDs, such as coronary artery disease, heart failure, and atrial fibrillation. Moreover, in all these clinical settings, vitamin deficiency seems to predispose to increased morbidity, mortality, and recurrent cardiovascular events. Despite this growing evidence, interventional trials with supplementation of vitamin D in patients at risk of or with established CVD are still controversial. In this review, we aimed to summarize the currently available evidence supporting the link between vitamin D deficiency and major CVDs in terms of its prevalence, clinical relevance, prognostic impact, and potential therapeutic implications.
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Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Valentina Milazzo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
| | - Monica De Metrio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
| | - Marta Brambilla
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
| | - Marina Camera
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
- Correspondence: ; Tel.: +39-02-580-021
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Rizzoni D, Rizzoni M, Nardin M. Vitamin D and Ischaemic Heart Disease: A Casual or A Causal Association? High Blood Press Cardiovasc Prev 2019; 26:151-155. [DOI: 10.1007/s40292-019-00302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 11/30/2022] Open
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Alspach JG. Vitamin D: Way More Important in Critical Care Than We May Have Recognized. Crit Care Nurse 2018; 37:11-15. [PMID: 28572095 DOI: 10.4037/ccn2017860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Kheiri B, Abdalla A, Osman M, Ahmed S, Hassan M, Bachuwa G. Vitamin D deficiency and risk of cardiovascular diseases: a narrative review. Clin Hypertens 2018; 24:9. [PMID: 29977597 PMCID: PMC6013996 DOI: 10.1186/s40885-018-0094-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/04/2018] [Indexed: 12/17/2022] Open
Abstract
Vitamin D, a fat-soluble prohormone, has wide-ranging roles in the regulation of many physiological processes through their interactions with the vitamin D receptors (VDR). It plays a major role in bones and calcium metabolism. Vitamin D deficiency is not uncommon and it has been associated with many health-related issues, including skeletal and non-skeletal complications. The association of low vitamin D and cardiovascular diseases and risk factors has been explored in both animal and human studies. However, studies and trials on the effect of vitamin D supplementation on cardiovascular risk factors and hypertension are conflicting with inconsistent results. Therefore, large, well-powered randomized controlled trials are warranted. If successful, supplementation with easy and low-cost vitamin D can impact our health positively. Here, we summarized the evidence for the association of vitamin D, cardiovascular diseases and risk factors, including coronary artery diseases, stroke, and hypertension, and mortality, with special consideration to resistant hypertension.
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Affiliation(s)
- Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Two Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Ahmed Abdalla
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Two Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Mohammed Osman
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Two Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Sahar Ahmed
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Two Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Mustafa Hassan
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Two Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Two Hurley Plaza, Suite 212, Flint, MI 48503 USA
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Makoui RH, Soltannejad Dizaji M, Khederlou H. Comparison of Serum Levels of Vitamin D in Patients With and Without Acute Coronary Syndrome. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2018. [DOI: 10.21859/ijcp-03201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Association between blood vitamin D and myocardial infarction: A meta-analysis including observational studies. Clin Chim Acta 2017. [DOI: 10.1016/j.cca.2017.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Grübler MR, März W, Pilz S, Grammer TB, Trummer C, Müllner C, Schwetz V, Pandis M, Verheyen N, Tomaschitz A, Fiordelisi A, Laudisio D, Cipolletta E, Iaccarino G. Vitamin-D concentrations, cardiovascular risk and events - a review of epidemiological evidence. Rev Endocr Metab Disord 2017; 18:259-272. [PMID: 28451877 DOI: 10.1007/s11154-017-9417-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vitamin D has long been established as an elemental factor of bone physiology. Beyond mineral metabolism, the expression of the vitamin D receptor has been identified throughout the cardiovascular (CV) system. Experimental studies showed beneficial effects of vitamin D on heart and vessels, but vitamin D intoxication in animals also led to hypercalcemia and vascular calcification. Our knowledge has been extended by epidemiological studies that showed that 25-hydroxyvitamin D (25(OH)D) levels are inversely associated with an increased CV risk itself, but also with established CV risk factors, such as arterial hypertension, endothelial dysfunction and atherosclerosis. Conversely, randomized controlled trials could not document significant and consistent effects of vitamin D supplementation on CV risk or events. Potential explanations may lie in differences in reference ranges or the possibility that low vitamin D in CV disease is only an epiphenomenon. In the latter case, the key question is why low 25(OH)D levels are such a strong predictor of health. While we wait for new data, the current conclusion is that vitamin D is a strong risk marker for CV risk factors and for CV diseases itself.
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Affiliation(s)
- Martin Robert Grübler
- Swiss Cardiovascular Centre Bern, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, and Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Synlab Academy, Synlab Services GmbH, and Augsburg, Mannheim, Germany
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands
| | - Tanja B Grammer
- Mannheim Institute of Public Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Christian Müllner
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Verena Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Marlene Pandis
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Nicolas Verheyen
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Andreas Tomaschitz
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
- Bad Gleichenberg Clinic, Schweizereiweg 4, 8344, Bad Gleichenberg, Austria
| | | | | | - Ersilia Cipolletta
- Department of Medicine, Surgery Odontoiatrics-Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Guido Iaccarino
- Department of Medicine, Surgery Odontoiatrics-Scuola Medica Salernitana, University of Salerno, Salerno, Italy
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Milazzo V, De Metrio M, Cosentino N, Marenzi G, Tremoli E. Vitamin D and acute myocardial infarction. World J Cardiol 2017; 9:14-20. [PMID: 28163832 PMCID: PMC5253190 DOI: 10.4330/wjc.v9.i1.14] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/21/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
Vitamin D deficiency is a prevalent condition, cutting across all ethnicities and among all age groups, and occurring in about 30%-50% of the population. Besides vitamin D established role in calcium homeostasis, its deficiency is emerging as a new risk factor for coronary artery disease. Notably, clinical investigations have suggested that there is an association between hypovitaminosis D and acute myocardial infarction (AMI). Not only has it been linked to incident AMI, but also to increased morbidity and mortality in this clinical setting. Moreover, vitamin D deficiency seems to predispose to recurrent adverse cardiovascular events, as it is associated with post-infarction complications and cardiac remodeling in patients with AMI. Several mechanisms underlying the association between vitamin D and AMI risk can be involved. Despite these observational and mechanistic data, interventional trials with supplementation of vitamin D are controversial. In this review, we will discuss the evidence on the association between vitamin D deficiency and AMI, in terms of prevalence and prognostic impact, and the possible mechanisms mediating it. Further research in this direction is warranted and it is likely to open up new avenues for reducing the risk of AMI.
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12
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Karur S, Veerappa V, Nanjappa MC. Study of vitamin D deficiency prevalence in acute myocardial infarction. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:57-59. [PMID: 29450171 PMCID: PMC5801269 DOI: 10.1016/j.ijchv.2014.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Deficiency of 25-hydroxy vitamin D [25(OH)D] is a treatable condition that has been associated with coronary artery disease and many of its risk factors. A practical time to assess for 25(OH)D deficiency, and to initiate treatment, is at the time of an acute myocardial infarction(AMI). The prevalence of 25(OH)D deficiency and the characteristics associated with it in patients with acute myocardial infarction are unknown. METHODS In this study 25(OH)D was assessed in 314 subjects enrolled in a Sri Jayadeva Institute of Cardiovascular Science and Research(SJICS&R). Patients enrolled from December 1, 2011 to February 28, 2012 had serum samples sent to a centralized laboratory for analysis using the ELECYS assay. Normal 25(OH)D levels are ≥ 30 ng/ml, and patients with levels < 30 and > 20 ng/ml were classified as insufficient and those with levels ≤ 20 ng/ml as deficient. Vitamin D and other baseline characteristics were analyzed with T-test and chi-squared test. RESULTS Of the 314 enrolled patents, 212 (67.5%) were 25(OH)D deficient and 50(16%) were insufficient, for a total of 83.5% of patients with abnormally low 25(OH)D levels. No significant heterogeneity was observed among age or gender sub groups but 25(OH)D deficiency was more commonly seen in those with lower socioeconomic status, lower activity levels, diabetes, hypercholesterolemia(LDL), hypertriglyceridemia and in smokers. CONCLUSION Vitamin D deficiency is present in most of the patients with acute myocardial infarction and it is associated with many of its risk factors in our study.
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Affiliation(s)
- Satish Karur
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Road, Jayanagar 9th Block, Bangalore, Karnataka 560069, India
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Arnson Y, Itzhaky D, Mosseri M, Barak V, Tzur B, Agmon-Levin N, Amital H. Vitamin D inflammatory cytokines and coronary events: a comprehensive review. Clin Rev Allergy Immunol 2014; 45:236-47. [PMID: 23314982 DOI: 10.1007/s12016-013-8356-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Myocardial infarction (MI) is the most common cause of cardiac injury in the Western world. Cardiac injury activates innate immune mechanisms initiating an inflammatory reaction. Inflammatory cytokines and vascular cell adhesion molecules (VCAM) promote adhesive interactions between leukocytes and endothelial cells, resulting in the transmigration of inflammatory cells into the site of injury. Low vitamin D levels are associated with higher prevalence of cardiovascular risk factors and a higher risk of MI. In this paper, we examine the effects of short-term vitamin D supplementation on inflammatory cytokine levels after an acute coronary syndrome. We recruited patients arriving to the hospital with an acute MI. All patients received optimal medical therapy and underwent a coronary catheterization. Half of the patients were randomly selected and treated with a daily supplement of vitamin D (4,000 IU) for 5 days. A short course of treatment with vitamin D effectively attenuated the increase in circulating levels of inflammatory cytokines after an acute coronary event. Control group patients had increased cytokine and cellular adhesion molecules serum concentrations after 5 days, while the vitamin D-treated group had an attenuated elevation or a reduction of these parameters. There were significant differences in VCAM-1 levels, C-reactive protein, and interleukin-6. There were trends toward significance in interleukin-8 levels. There were no significant differences in circulating levels of intercellular adhesion molecule 1, E-selectin, vascular endothelial growth factor, and tumor necrosis factor-α. These findings provide information on the anti-inflammatory effects of vitamin D on the vascular system and suggest mechanisms that mediate some of its cardioprotective properties. There is place for further studies involving prolonged vitamin D treatment in patients suffering from ischemic heart disease.
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Affiliation(s)
- Yoav Arnson
- Cardiology Division, Meir Medical Center, Kfar Saba, Israel
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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: 2.8] [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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15
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Wang C. Role of vitamin d in cardiometabolic diseases. J Diabetes Res 2013; 2013:243934. [PMID: 23671861 PMCID: PMC3647592 DOI: 10.1155/2013/243934] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/09/2013] [Accepted: 01/09/2013] [Indexed: 01/08/2023] Open
Abstract
Vitamin D deficiency is a highly prevalent condition. Low vitamin D levels have long been associated with bone diseases, such as rickets in children and osteomalacia and osteoporosis in adults. However, it has become apparent in recent years that adequate vitamin D levels are also important for optimal functioning of many organs and tissues throughout the body, including the cardiovascular system. Evolving data indicate that vitamin D deficiency is associated with an increased risk of cardiovascular disease (CVD). Studies have shown that low vitamin D levels are associated with hypertension, diabetes, metabolic syndrome, left ventricular hypertrophy, and chronic vascular inflammation, all of which are risk factors for CVD. This paper reviews the definition and pathophysiology of vitamin D deficiency, clinical evidence linking vitamin D and CVD risk, diabetes and its complications, and metabolic syndrome.
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Affiliation(s)
- Chaoxun Wang
- Department of Endocrinology, Shanghai Pudong Hospital, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai 201399, China
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Abstract
Vitamin D may influence blood pressure through the renin-angiotensin system, parathyroid hormone levels, myocardial function, inflammation, and vascular calcification. In the past several years, a number of high-quality prospective studies have examined 25(OH)vitamin D (25(OH)D) levels in relation to risk of cardiovascular disease (CVD). Studies consistently show that levels of 25(OH)D below 20-25 ng/mL are associated with an increased risk of CVD incidence or mortality. Risk appears especially elevated at 25(OH)D levels below 10 or 15 ng/mL. It is unclear if levels higher that 25 ng/mL provide further benefits for CVD disease. Currently, results from randomized clinical trials are sparse and do not allow a definitive conclusion. Given other potential benefits of vitamin D, and low potential for toxicity, deficient levels below 25-30 ng/mL should be avoided and treated when identified. Further observational and randomized clinical trial data are important to better characterize the optimal range for 25(OH)D.
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Affiliation(s)
- Monica Leu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels vag 12a, Stockholm, Sweden.
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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: 43] [Impact Index Per Article: 3.1] [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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Wasson LT, Shimbo D, Rubin MR, Shaffer JA, Schwartz JE, Davidson KW. Is vitamin D deficiency a risk factor for ischemic heart disease in patients with established cardiovascular disease? 10-year follow-up of the Nova Scotia Health Survey. Int J Cardiol 2011; 148:387-9. [PMID: 21396725 PMCID: PMC3081382 DOI: 10.1016/j.ijcard.2010.12.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 12/04/2010] [Indexed: 01/24/2023]
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Goliasch G, Blessberger H, Azar D, Heinze G, Wojta J, Bieglmayer C, Wagner O, Schillinger M, Huber K, Maurer G, Haas M, Wiesbauer F. Markers of bone metabolism in premature myocardial infarction (≤ 40 years of age). Bone 2011; 48:622-6. [PMID: 21078422 DOI: 10.1016/j.bone.2010.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 09/15/2010] [Accepted: 11/06/2010] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) at young age is a rare disease with a poor prognosis. Bone metabolism parameters such as 1,25 (OH)₂ vitamin D₃, 25 (OH) vitamin D₃ and osteocalcin have been recently implicated in the development of coronary heart disease (CHD). We evaluated the role of these serum markers in a study population of very young AMI survivors (≤ 40 years). METHODS AND RESULTS We prospectively enrolled 302 subjects into our multi-center case control study, including 102 young myocardial infarction patients (≤ 40 years) and 200 control subjects who were frequency-matched on gender and age in an approximate 2:1 ratio per case patient. In the adjusted logistic regression analysis, we used baseline laboratory measurements for the first analysis (acute phase analysis) and measurements from one-year follow-up visits (stable phase analysis). In both, elevated levels of 25 (OH) vitamin D₃ (acute phase: OR per IQR 2.02, 95% CI 1.13-3.58, p = 0.017; stable phase: OR 4.07, 95% CI 1.8-9.21, p = 0.001) and 1,25 (OH)₂ vitamin D₃ (acute phase: OR 2.82, 95% CI 1.7-4.7, p < 0.001; stable phase: OR 4.57, 95% CI 2.31-9.05, p < 0.001) were associated with premature AMI. Conversely, osteocalcin was inversely associated with premature myocardial infarction (acute phase: OR 0.53, 95% CI 0.28-1.03, p = 0.059; stable phase: OR 0.26, 95% CI 0.12-0.6, p < 0.001). The observed associations were independent of the acute phase of myocardial infarction. CONCLUSION In our study, elevated levels of 25 (OH) vitamin D₃ and 1,25 (OH)₂ vitamin D₃, as well as decreased levels of osteocalcin were associated with myocardial infarction in very young patients. The precise mechanism and implications of these findings will have to be elucidated in future studies.
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Affiliation(s)
- Georg Goliasch
- Department of Cardiology, Vienna General Hospital/Medical University of Vienna, Austria
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Barnard K, Colón-Emeric C. Extraskeletal effects of vitamin D in older adults: cardiovascular disease, mortality, mood, and cognition. ACTA ACUST UNITED AC 2010; 8:4-33. [PMID: 20226390 DOI: 10.1016/j.amjopharm.2010.02.004] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2009] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vitamin D insufficiency is prevalent among older adults and may be associated with higher risk for cardiovascular (CV) disease, mortality, depression, and cognitive deficits. OBJECTIVE The aim of this article was to review published observational and experimental studies that explored the association between vitamin D insufficiency and CV disease, mortality, mood, and cognition with an emphasis on older adults. METHODS PubMed and Web of Science databases were searched for English-language articles from January 1966 through June 2009 relating to vitamin D, using the following MeSH terms: aged, vitamin D deficiency, physiopathology, drug therapy, cardiovascular diseases, blood pressure, mortality, delirium, dementia, cognitive disorders, depression, depressive disorder, seasonal affective disorder, mental disorders, and vitamin D/therapeutic use. Publications had to include patients > or =65 years of age who had > or =1 recorded measurement of 25-hydroxyvitamin D (25[OH]D) or were receiving vitamin D supplementation. All case-control, cohort, and randomized studies were reviewed. RESULTS Forty-two case-control, cohort, and randomized trials were identified and included in the review. Based on these publications, the prevalence of vitamin D insufficiency (25[OH]D concentration <30 ng/mL) in communitydwelling older adults (> or =65 years of age) ranged from 40% to 100%. Epidemiologic data and several small randomized trials found a potential association between vitamin D deficiency (25[OH]D concentration <10 ng/mL) and CV disease, including hypertension and ischemic heart disease. Although subgroup analyses of data from the Women's Health Initiative Randomized Trial (the largest randomized, placebo-controlled trial of vitamin D plus calcium therapy) did not find reductions in blood pressure, myocardial infarction, or CV disease-related deaths, intervention contamination limited the findings. Observational studies and a meta-analysis of randomized controlled trials found a mortality benefit associated with higher serum 25(OH)D concentrations or vitamin D(2) or D(3) supplementation (mean dose, 528 IU/d). Observational and small randomized trials found a potential benefit of sunlight or vitamin D on symptoms of depression and cognition, but the findings were limited by methodologic problems. CONCLUSIONS Vitamin D insufficiency appears to be highly prevalent among older adults. Evidence from epidemiologic studies and small clinical trials suggests an association between 25(OH)D concentrations and systolic blood pressure, risk for CV disease-related deaths, symptoms of depression, cognitive deficits, and mortality. The Women's Health Initiative Randomized Trial did not find a benefit of vitamin D supplementation on blood pressure, myocardial infarction, or mortality in postmenopausal women.
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Affiliation(s)
- Karen Barnard
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
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Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, Kandala NB, Clarke A, Franco OH. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas 2009; 65:225-36. [PMID: 20031348 DOI: 10.1016/j.maturitas.2009.12.013] [Citation(s) in RCA: 294] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 12/10/2009] [Indexed: 02/06/2023]
Abstract
Cardiometabolic disorders and vitamin D deficiency are becoming increasingly more prevalent across multiple populations. Different studies have suggested a potential association between abnormal vitamin D levels and multiple pathological conditions including cardiovascular diseases and diabetes. We aimed to evaluate the association between vitamin D levels, using 25-hydroxy vitamin D (25OHD) as an indicator of vitamin D status, and the presence of cardiometabolic disorders including cardiovascular disease, diabetes and metabolic syndrome. We performed a systematic review of the current literature on vitamin D and cardiometabolic disorders using the PubMed and Web of Knowledge databases in September 2009. Studies in adults looking at the effect of vitamin D levels on outcomes relating to cardiometabolic disorders were selected. We performed a meta-analysis to assess the risk of developing cardiometabolic disorders comparing the highest and lowest groups of serum 25OHD. From 6130 references we identified 28 studies that met our inclusion criteria, including 99,745 participants. There was moderate variation between the studies in their grouping of 25OHD levels, design and analytical approach. We found that the highest levels of serum 25OHD were associated with a 43% reduction in cardiometabolic disorders [OR 0.57, 95% (CI 0.48-0.68)]. Similar levels were observed, irrespective of the individual cardiometabolic outcome evaluated or study design. High levels of vitamin D among middle-age and elderly populations are associated with a substantial decrease in cardiovascular disease, type 2 diabetes and metabolic syndrome. If the relationship proves to be causal, interventions targeting vitamin D deficiency in adult populations could potentially slow the current epidemics of cardiometabolic disorders.
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Affiliation(s)
- Johanna Parker
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
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Nemerovski CW, Dorsch MP, Simpson RU, Bone HG, Aaronson KD, Bleske BE. Vitamin D and Cardiovascular Disease. Pharmacotherapy 2009; 29:691-708. [DOI: 10.1592/phco.29.6.691] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Grant WB. The Health Benefits of Solar Irradiance and Vitamin D and the Consequences of Their Deprivation. Clin Rev Bone Miner Metab 2009. [DOI: 10.1007/s12018-009-9029-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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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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Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. ARCHIVES OF INTERNAL MEDICINE 2008; 168:1174-80. [PMID: 18541825 PMCID: PMC3719391 DOI: 10.1001/archinte.168.11.1174] [Citation(s) in RCA: 807] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vitamin D deficiency may be involved in the development of atherosclerosis and coronary heart disease in humans. METHODS We assessed prospectively whether plasma 25-hydroxyvitamin D (25[OH]D) concentrations are associated with risk of coronary heart disease. A nested case-control study was conducted in 18,225 men in the Health Professionals Follow-up Study; the men were aged 40 to 75 years and were free of diagnosed cardiovascular disease at blood collection. The blood samples were returned between April 1, 1993, and November 30, 1999; 99% were received between April 1, 1993, and November 30, 1995. During 10 years of follow-up, 454 men developed nonfatal myocardial infarction or fatal coronary heart disease. Using risk set sampling, controls (n = 900) were selected in a 2:1 ratio and matched for age, date of blood collection, and smoking status. RESULTS After adjustment for matched variables, men deficient in 25(OH)D (or=30 ng/mL) (relative risk [RR], 2.42; 95% confidence interval [CI], 1.53-3.84; P < .001 for trend). After additional adjustment for family history of myocardial infarction, body mass index, alcohol consumption, physical activity, history of diabetes mellitus and hypertension, ethnicity, region, marine omega-3 intake, low- and high-density lipoprotein cholesterol levels, and triglyceride levels, this relationship remained significant (RR, 2.09; 95% CI, 1.24-3.54; P = .02 for trend). Even men with intermediate 25(OH)D levels were at elevated risk relative to those with sufficient 25(OH)D levels (22.6-29.9 ng/mL: RR, 1.60 [95% CI, 1.10-2.32]; and 15.0-22.5 ng/mL: RR, 1.43 [95% CI, 0.96-2.13], respectively). CONCLUSION Low levels of 25(OH)D are associated with higher risk of myocardial infarction in a graded manner, even after controlling for factors known to be associated with coronary artery disease.
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Affiliation(s)
- Edward Giovannucci
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA.
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Anand K, Aryana A, Cloutier D, Hee T, Esterbrooks D, Mooss AN, Mohiuddin SM. Circadian, daily, and seasonal distributions of ventricular tachyarrhythmias in patients with implantable cardioverter-defibrillators. Am J Cardiol 2007; 100:1134-8. [PMID: 17884377 DOI: 10.1016/j.amjcard.2007.04.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 04/25/2007] [Accepted: 04/25/2007] [Indexed: 11/17/2022]
Abstract
This study investigated the circadian, daily, and seasonal distributions of ventricular arrhythmias in patients with new implantable cardioverter-defibrillator placement at Creighton University Medical Center from January 2000 to December 2004. The incidence and distribution of ventricular tachyarrhythmias as recorded by implantable cardioverter-defibrillators were analyzed with respect to season, month, day of the week, and average daily temperature. Data from 154 consecutive patients (mean age 67 +/- 14 years; 78% men, 71% with ischemic heart disease [IHD], mean left ventricular ejection fraction 34 +/- 15%) were analyzed. During a mean follow-up of 35 +/- 19 months, a total of 1,055 episodes of spontaneously terminated ventricular tachycardia (VT) and 612 episodes of VT or ventricular fibrillation with appropriate device therapy occurred. Distributions in the incidence of VT and VT or ventricular fibrillation receiving appropriate therapy were similar in patients with IHD and non-IHD. Spontaneously terminated VT and appropriately treated VT or ventricular fibrillation episodes occurred with the greatest incidence in the winter months and the lowest incidence in summer, spring, and fall. A linear regression between the number of episodes and the average daily temperature showed a greater likelihood of the 2 events occurring on cooler days, irrespective of the cause of cardiac disease. A weekly distribution was also observed, with the greatest proportion of episodes occurring on Fridays and the lowest on Saturdays and Sundays. A bimodal circadian distribution was present, with the greatest peak occurring from 8 a.m. to 1 p.m. and a smaller peak occurring from 5 p.m. to 10 p.m. In conclusion, the occurrence of ventricular tachyarrhythmias appears to follow circadian, daily, and seasonal distributions that are similar in patients with IHD and non-IHD. The incidence inversely correlates with average daily temperatures.
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Affiliation(s)
- Kishlay Anand
- Department of Internal Medicine, Creighton University, Omaha, Nebraska, USA
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John WG, Noonan K, Mannan N, Boucher BJ. Hypovitaminosis D is associated with reductions in serum apolipoprotein A-I but not with fasting lipids in British Bangladeshis. Am J Clin Nutr 2005. [DOI: 10.1093/ajcn/82.3.517] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- W Garry John
- From the Centre for Diabetes and Metabolic Medicine, Queen Mary School of Medicine and Dentistry, University of London, London, United Kingdom (NM and BJB), and the Department of Clinical Chemistry, Bart’s and The London NHS Trust, London, United Kingdom (WGJ and KN)
| | - Kate Noonan
- From the Centre for Diabetes and Metabolic Medicine, Queen Mary School of Medicine and Dentistry, University of London, London, United Kingdom (NM and BJB), and the Department of Clinical Chemistry, Bart’s and The London NHS Trust, London, United Kingdom (WGJ and KN)
| | - Nasima Mannan
- From the Centre for Diabetes and Metabolic Medicine, Queen Mary School of Medicine and Dentistry, University of London, London, United Kingdom (NM and BJB), and the Department of Clinical Chemistry, Bart’s and The London NHS Trust, London, United Kingdom (WGJ and KN)
| | - Barbara J Boucher
- From the Centre for Diabetes and Metabolic Medicine, Queen Mary School of Medicine and Dentistry, University of London, London, United Kingdom (NM and BJB), and the Department of Clinical Chemistry, Bart’s and The London NHS Trust, London, United Kingdom (WGJ and KN)
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John WG, Noonan K, Mannan N, Boucher BJ. Hypovitaminosis D is associated with reductions in serum apolipoprotein A-I but not with fasting lipids in British Bangladeshis. Am J Clin Nutr 2005; 82:517-22. [PMID: 16155262 DOI: 10.1093/ajcn.82.3.517] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although hypovitaminosis D has been suggested to increase the risk of heart disease, its relation to components of the fasting lipid profile has not been clarified for specific ethnic groups. OBJECTIVE The objective was to determine the relation of circulating 25-hydroxyvitamin D [25(OH)D] concentrations to fasting lipid concentrations in South Asian subjects at risk of hypovitaminosis D. DESIGN The present study was conducted in 170 British Bangladeshi adults, 69 men and 101 women, from east London who were free of known diabetes or chronic disorders. Vitamin D repletion was assessed by measuring fasting serum 25(OH)D concentrations. Fasting lipid profiles were measured as part of a study of the risk factors for type 2 diabetes and ischemic heart disease, which included hypovitaminosis D. RESULTS A univariate analysis showed that total cholesterol, LDL cholesterol, and both apolipoprotein (apo) A-I and apo B concentrations correlated directly with serum 25(OH)D concentrations. However, a multiple regression analysis, which included all the documented risk factors for diabetes and ischemic heart disease, showed that the 25(OH)D concentration (vitamin D status) was an independent predictor of increasing apo A-I concentrations (standardized coefficient beta = 0.3; P < 0.001) but not of fasting lipid concentrations. CONCLUSIONS In this study of British South Asians, the data showed a positive relation of fasting apo A-I concentrations to serum 25(OH)D concentrations, independent of glycemia and other dietary, anthropometric, and lifestyle risk factors for type 2 diabetes and ischemic heart disease after multiple regression analyses. Subjects with hypovitaminosis D are likely to have an increased risk of ischemic heart disease independent of their increased risk of type 2 diabetes.
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Affiliation(s)
- W Garry John
- Centre for Diabetes and Metabolic Medicine, Queen Mary School of Medicine and Dentistry, University of London, London, United Kingdom
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Vieth R, Scragg R. Vitamin D Nutrition Does Not Cause Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2005; 25:e41; author reply e41-2. [PMID: 15863715 DOI: 10.1161/01.atv.0000164308.43228.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ness AR, Frankel SJ, Gunnell DJ, Smith GD. Are we really dying for a tan? BMJ (CLINICAL RESEARCH ED.) 1999; 319:114-6. [PMID: 10398641 PMCID: PMC1116197 DOI: 10.1136/bmj.319.7202.114] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A R Ness
- University of Bristol, Department of Social Medicine, Bristol BS6 7DP.
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Spencer FA, Goldberg RJ, Becker RC, Gore JM. Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction. J Am Coll Cardiol 1998; 31:1226-33. [PMID: 9581712 DOI: 10.1016/s0735-1097(98)00098-9] [Citation(s) in RCA: 337] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This observational study sought to determine whether cases of acute myocardial infarction (AMI) reported to the second National Registry of Myocardial Infarction (NRMI-2) varied by season. BACKGROUND The existence of circadian variation in the onset of AMI is well established. Examination of this periodicity has led to new insights into pathophysiologic triggers of atherosclerotic plaque rupture. Although a seasonal pattern for mortality from AMI has been previously noted, it remains unclear whether the occurrence of AMI also displays a seasonal rhythmicity. Documentation of such a pattern may foster investigation of new pathophysiologic determinants of plaque rupture and intracoronary thrombosis. METHODS We analyzed the number of cases of AMI reported to NRMI-2 by season during the period July 1, 1994 to July 31, 1996. Data were normalized so that seasonal occurrence of AMI was reported according to a standard 90-day length. RESULTS A total of 259,891 cases of AMI were analyzed during the study period. Approximately 53% more cases were reported in winter than during the summer. The same seasonal pattern (decreasing occurrence of reported cases from winter to fall to spring to summer) was seen in men and women, in different age groups and in 9 of 10 geographic areas. In-hospital case fatality rates for AMI also followed a seasonal pattern, with a peak of 9% in winter. CONCLUSION The present results suggest that there is a seasonal pattern in the occurrence of AMIs reported to NRMI-2 that is characterized by a marked peak of cases in the winter months and a nadir in the summer months. This pattern was seen in all subgroups analyzed as well as in different geographic areas. These findings suggest that the chronobiology of seasonal variation in AMI may be affected by variables independent of climate.
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Affiliation(s)
- F A Spencer
- Cardiovascular Thrombosis Research Center, Department of Medicine, University of Massachusetts Medical Center, Worcester 01655, USA.
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Scragg R, Holdaway I, Singh V, Metcalf P, Baker J, Dryson E. Serum 25-hydroxyvitamin D3 is related to physical activity and ethnicity but not obesity in a multicultural workforce. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1995; 25:218-23. [PMID: 7487689 DOI: 10.1111/j.1445-5994.1995.tb01526.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recent research suggests that body vitamin D levels are decreased in coronary heart disease and diabetes, but it is unclear which cardiovascular risk factors are related to vitamin D status. AIMS To examine the relation between vitamin D status and major cardiovascular risk factors. METHODS Serum 25-hydroxyvitamin D3, a marker of recent sun exposure and vitamin D status, was measured in 390 New Zealand residents (95 Pacific Islanders, 74 Maori and 221 others mostly of European descent), who were part of a larger cross-sectional survey of a workforce (n = 5677) aged 40-64 years. RESULTS Serum 25-hydroxyvitamin D3 levels were significantly lower in Pacific Islanders (mean (SE) = 56 (3) nmol/L; p = 0.0001) and Maoris (68 (3) nmol/L; p = 0.036) compared with Europeans (75 (2) nmol/L) after adjusting for age, sex and time of year. Also adjusting for ethnic group, 25-hydroxyvitamin D3 was higher in people doing vigorous (aerobic) leisure physical activities (71 (2) nmol/L; p = 0.0066) and moderate (non-aerobic) activities (68 (3) nmol/L; p = 0.12) compared with those who were inactive (63 (2) nmol/L). However, 25-hydroxyvitamin D3 was unrelated to body mass index, serum lipids, blood pressure or cigarette smoking. CONCLUSIONS People with increased skin pigmentation, such as Polynesians, and people who are inactive, have decreased body levels of vitamin D; this might partly explain their increased risk of cardiovascular disease.
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Affiliation(s)
- R Scragg
- Department of Community Health, University of Auckland, New Zealand
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Scragg R, Holdaway I, Jackson R, Lim T. Plasma 25-hydroxyvitamin D3 and its relation to physical activity and other heart disease risk factors in the general population. Ann Epidemiol 1992; 2:697-703. [PMID: 1342321 DOI: 10.1016/1047-2797(92)90014-h] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The relation between plasma levels of 25-hydroxyvitamin D3, the main metabolite of sun-induced vitamin D, and major coronary heart disease risk factors was examined in 295 men, aged 35 to 64 years, who were randomly sampled from the general population. Men who did regular vigorous leisure-time activity had a mean plasma 25-hydroxyvitamin D3 level that was 4.8 nmol/L (95% confidence limits: 0.1, 9.5) higher than that in inactive men, with the increase greatest in the winter months. Plasma 25-hydroxyvitamin D3 was positively associated with weekly hours of sun exposure (r = 0.27, P < 0.01), and showed a weak inverse association with age (r = -0.12, P < 0.05) and diastolic blood pressure (r = -0.15, P < 0.05), although this latter finding was no longer significant when allowance was made for the effects of age and season on vitamin D levels. In contrast, plasma 25-hydroxyvitamin D3 had no relation with either serum total or high-density-lipoprotein cholesterol levels, body mass index, or cigarette smoking. We hypothesize that vigorous leisure-time activity may protect against coronary heart disease, in part, by increasing body levels of vitamin D.
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Affiliation(s)
- R Scragg
- Department of Community Health, University of Auckland, New Zeland
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Scragg R, Jackson R, Holdaway I, Woollard G, Woollard D. Changes in plasma vitamin levels in the first 48 hours after onset of acute myocardial infarction. Am J Cardiol 1989; 64:971-4. [PMID: 2816755 DOI: 10.1016/0002-9149(89)90792-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To establish whether plasma vitamin measurements made after acute myocardial infarction (AMI) can be used in case-control studies of coronary artery disease, the short-term effect of AMI on plasma concentrations of 25-hydroxyvitamin D3, beta-carotene, vitamin E and retinol was investigated. Sequential measures of these vitamins were made during the first 48 hours after AMI in 13 patients admitted to the hospital within 4 hours after the onset of symptoms. Plasma levels of 25-hydroxyvitamin D did not change significantly during the first 12 hours after onset of symptoms. Beta-carotene levels increased significantly (p less than 0.05) during the first 12 hours and then decreased, whereas levels of vitamin E and retinol progressively decreased during the first 48 hours by 26 and 25%, respectively. These results suggest that, of these vitamins, only plasma measurements of 25-hydroxyvitamin D3 collected within 12 hours of onset of symptoms may provide reliable information for case-control studies of AMI.
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Affiliation(s)
- R Scragg
- Department of Community Health, University of Auckland, New Zealand
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Abstract
In a double-blind, placebo-controlled study, 273 patients with suspected acute myocardial infarction (AMI) were randomised to receive either magnesium intravenously or placebo immediately on admission to hospital. Of 130 patients with proven AMI 56 received magnesium and 74 received placebo. During the first 4 weeks after treatment mortality was 7% in the magnesium group and 19% in the placebo group. In the magnesium group 21% of patients had arrhythmias that needed treatment, compared with 47% in the placebo group. No adverse effects of intravenous magnesium were observed.
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Ebel H, Günther T. Role of magnesium in cardiac disease. JOURNAL OF CLINICAL CHEMISTRY AND CLINICAL BIOCHEMISTRY. ZEITSCHRIFT FUR KLINISCHE CHEMIE UND KLINISCHE BIOCHEMIE 1983; 21:249-65. [PMID: 6348202 DOI: 10.1515/cclm.1983.21.5.249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Some aspects of the pathogenesis of cardiac disease are reviewed in the light of current knowledge of the physiological and biochemical actions of magnesium (Mg2+) on heart function. Several authors have reported a reduction of the human myocardial Mg2+ content in areas with (Mg2+ poor) soft water, without a significant alteration of Mg2+ in serum or skeletal muscle. In human during myocardial infarction, there is a reduction of Mg2+ content even in noninfarcted areas of the myocardium, followed by a transient reduction of serum Mg2+ concentration. These effects are explained by the action of catecholamines on the myocardial cells, resulting in a loss of Mg2+ accompanied by a catecholamine-induced urinary Mg2+ loss and/or increased lipolysis which binds Mg2+ as Mg2+ soaps in the adipocytes. As a consequence serum Mg2+ may be decreased. A reduced serum Mg2+ concentration may enhance the action of catecholamines on the heart muscle as well as the action of vasopressive hormones, thus provoking contraction of coronary artery smooth muscle cells and favouring the development of arrhythmia.
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