Advertisement

Role of Vitamin D in Cardiovascular Health

      Observational studies strongly associate vitamin D deficiency with a variety of cardiovascular diseases beyond defects in bone and calcium metabolism. Vitamin D has multiple mechanisms that potentially may affect cardiovascular health. Because vitamin D deficiency is common, therapies directed at the replacement of vitamin D may be beneficial. To date however, studies evaluating vitamin D supplementation are few and have not consistently shown benefit. It is possible that the lack of benefit in these studies may have arisen from suboptimal levels of vitamin D supplementation or other unknown factors. Nevertheless, the growing body of observational data and consistent findings of relatively high rates of low vitamin D serum levels warrant further well-designed studies to investigate the relation between vitamin D and cardiovascular health. In conclusion, vitamin D is now recognized as important for cardiovascular health and its deficiency as a potential risk factor for several cardiovascular disease processes.
      To read this article in full you will need to make a payment

      References

        • DeLuca H.F.
        Overview of general physiologic features and functions of vitamin D.
        Am J Clin Nutr. 2004; 80: 1689S-1696S
        • Nibbelink K.A.
        • Tishkoff D.X.
        • Hershey S.D.
        • Rahman A.
        • Simpson R.U.
        1,25(OH)2-vitamin D3 actions on cell proliferation, size, gene expression, and receptor localization, in the HL-1 cardiac myocyte.
        J Steroid Biochem Mol Biol. 2007; 103: 533-537
        • Pilz S.
        • Tomaschitz A.
        • Ritz E.
        • Pieber T.R.
        Vitamin D status and arterial hypertension: a systematic review.
        Nat Rev Cardiol. 2009; 6: 621-630
        • Vieth R.
        Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety.
        Am J Clin Nutr. 1999; 69: 842-856
        • Calvo M.S.
        • Whiting S.J.
        • Barton C.N.
        Vitamin D fortification in the United States and Canada: current status and data needs.
        Am J Clin Nutr. 2004; 80: 1710S-1716S
        • Kim D.H.
        • Sabour S.
        • Sagar U.N.
        • Adams S.
        • Whellan D.J.
        Prevalence of hypovitaminosis D in cardiovascular diseases (from the National Health and Nutrition Examination Survey 2001 to 2004).
        Am J Cardiol. 2008; 102: 1540-1544
        • Holick M.F.
        Vitamin D deficiency.
        N Engl J Med. 2007; 357: 266-281
        • Lee J.H.
        • O'Keefe J.H.
        • Bell D.
        • Hensrud D.D.
        • Holick M.F.
        Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor?.
        J Am Coll Cardiol. 2008; 52: 1949-1956
        • Tangpricha V.
        • Pearce E.N.
        • Chen T.C.
        • Holick M.F.
        Vitamin D insufficiency among free-living healthy young adults.
        Am J Med. 2002; 112: 659-662
        • Harris S.S.
        • Soteriades E.
        • Coolidge J.A.
        • Mudgal S.
        • Dawson-Hughes B.
        Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population.
        J Clin Endocrinol Metab. 2000; 85: 4125-4130
        • Looker A.C.
        • Dawson-Hughes B.
        • Calvo M.S.
        • Gunter E.W.
        • Sahyoun N.R.
        Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III.
        Bone. 2002; 30: 771-777
        • Heaney R.P.
        • Davies K.M.
        • Chen T.C.
        • Holick M.F.
        • Barger-Lux M.J.
        Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol.
        Am J Clin Nutr. 2003; 77: 204-210
        • Holick M.F.
        • Biancuzzo R.M.
        • Chen T.C.
        • Klein E.K.
        • Young A.
        • Bibuld D.
        • Reitz R.
        • Salameh W.
        • Ameri A.
        • Tannenbaum A.D.
        Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D.
        J Clin Endocrinol Metab. 2008; 93: 677-681
        • Bischoff-Ferrari H.A.
        • Giovannucci E.
        • Willett W.C.
        • Dietrich T.
        • Dawson-Hughes B.
        Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes.
        Am J Clin Nutr. 2006; 84: 18-28
        • Hall L.M.
        • Kimlin M.G.
        • Aronov P.A.
        • Hammock B.D.
        • Slusser J.R.
        • Woodhouse L.R.
        • Stephensen C.B.
        Vitamin D intake needed to maintain target serum 25-hydroxyvitamin D concentrations in participants with low sun exposure and dark skin pigmentation is substantially higher than current recommendations.
        J Nutr. 2010; 140: 542-550
        • Stechschulte S.A.
        • Kirsner R.S.
        • Federman D.G.
        Vitamin D: bone and beyond, rationale and recommendations for supplementation.
        Am J Med. 2009; 122: 793-802
        • Hathcock J.N.
        • Shao A.
        • Vieth R.
        • Heaney R.
        Risk assessment for vitamin D.
        Am J Clin Nutr. 2007; 85: 6-18
        • Stephenson D.W.
        • Peiris A.N.
        The lack of vitamin D toxicity with megadose of daily ergocalciferol (D2) therapy: a case report and literature review.
        South Med J. 2009; 102: 765-768
        • Kimball S.
        • Vieth R.
        Self-prescribed high-dose vitamin D3: effects on biochemical parameters in two men.
        Ann Clin Biochem. 2008; 45: 106-110
        • Resnick L.M.
        • Muller F.B.
        • Laragh J.H.
        Calcium-regulating hormones in essential hypertension.
        Ann Intern Med. 1986; 105: 649-654
        • Li Y.C.
        • Kong J.
        • Wei M.
        • Chen Z.F.
        • Liu S.Q.
        • Cao L.P.
        1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system.
        J Clin Invest. 2002; 110: 229-238
        • Krause R.
        • Buhring M.
        • Hopfenmuller W.
        • Holick M.F.
        • Sharma A.M.
        Ultraviolet B and blood pressure.
        Lancet. 1998; 352: 709-710
        • Burgess E.D.
        • Hawkins R.G.
        • Watanabe M.
        Interaction of 1,25-dihydroxyvitamin D and plasma renin activity in high renin essential hypertension.
        Am J Hypertens. 1990; 3: 903-905
        • Tarcin O.
        • Yavuz D.G.
        • Ozben B.
        • Telli A.
        • Ogunc A.V.
        • Yuksel M.
        • Toprak A.
        • Yazici D.
        • Sancak S.
        • Deyneli O.
        • Akalin S.
        Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects.
        J Clin Endocrinol Metab. 2009; 94: 4023-4030
        • Duprez D.
        • de Buyzere M.
        • de Backer T.
        • Clement D.
        Relationship between vitamin D3 and the peripheral circulation in moderate arterial primary hypertension.
        Blood Press. 1994; 3: 389-393
        • Kristal-Boneh E.
        • Froom P.
        • Harari G.
        • Ribak J.
        Association of calcitriol and blood pressure in normotensive men.
        Hypertension. 1997; 30: 1289-1294
        • Scragg R.
        • Holdaway I.
        • Singh V.
        • Metcalf P.
        • Baker J.
        • Dryson E.
        Serum 25-hydroxycholecalciferol concentration in newly detected hypertension.
        Am J Hypertens. 1995; 8: 429-432
        • Scragg R.
        • Sowers M.
        • Bell C.
        Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey.
        Am J Hypertens. 2007; 20: 713-719
        • Sugden J.A.
        • Davies J.I.
        • Witham M.D.
        • Morris A.D.
        • Struthers A.D.
        Vitamin D improves endothelial function in patients with type 2 diabetes mellitus and low vitamin D levels.
        Diabet Med. 2008; 25: 320-325
        • Pfeifer M.
        • Begerow B.
        • Minne H.W.
        • Nachtigall D.
        • Hansen C.
        Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women.
        J Clin Endocrinol Metab. 2001; 86: 1633-1637
        • Witham M.D.
        • Nadir M.A.
        • Struthers A.D.
        Effect of vitamin D on blood pressure: a systematic review and meta-analysis.
        J Hypertens. 2009; 27: 1948-1954
        • Melamed M.L.
        • Muntner P.
        • Michos E.D.
        • Uribarri J.
        • Weber C.
        • Sharma J.
        • Raggi P.
        Serum 25-hydroxyvitamin D levels and the prevalence of peripheral arterial disease: results from NHANES 2001 to 2004.
        Arterioscler Thromb Vasc Biol. 2008; 28: 1179-1185
        • Targher G.
        • Bertolini L.
        • Padovani R.
        • Zenari L.
        • Scala L.
        • Cigolini M.
        • Arcaro G.
        Serum 25-hydroxyvitamin D3 concentrations and carotid artery intima-media thickness among type 2 diabetic patients.
        Clin Endocrinol (Oxf). 2006; 65: 593-597
        • Reis J.P.
        • Michos E.D.
        • von Muhlen D.
        • Miller III, E.R.
        Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease.
        Am J Clin Nutr. 2008; 88: 1469-1477
        • Fahrleitner A.
        • Dobnig H.
        • Obernosterer A.
        • Pilger E.
        • Leb G.
        • Weber K.
        • Kudlacek S.
        • Obermayer-Pietsch B.M.
        Vitamin D deficiency and secondary hyperparathyroidism are common complications in patients with peripheral arterial disease.
        J Gen Intern Med. 2002; 17: 663-669
        • Pittas A.G.
        • Lau J.
        • Hu F.B.
        • Dawson-Hughes B.
        The role of vitamin D and calcium in type 2 diabetes.
        J Clin Endocrinol Metab. 2007; 92: 2017-2029
        • Bland R.
        • Markovic D.
        • Hills C.E.
        • Hughes S.V.
        • Chan S.L.
        • Squires P.E.
        • Hewison M.
        Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in pancreatic islets.
        J Steroid Biochem Mol Biol. 2004; (121–125): 89-90
        • Zeitz U.
        • Weber K.
        • Soegiarto D.W.
        • Wolf E.
        • Balling R.
        • Erben R.G.
        Impaired insulin secretory capacity in mice lacking a functional vitamin D receptor.
        FASEB J. 2003; 17: 509-511
        • Bourlon P.M.
        • Faure-Dussert A.
        • Billaudel B.
        The de novo synthesis of numerous proteins is decreased during vitamin D3 deficiency and is gradually restored by 1, 25-dihydroxyvitamin D3 repletion in the islets of Langerhans of rats.
        J Endocrinol. 1999; 162: 101-109
        • Maestro B.
        • Campion J.
        • Davila N.
        • Calle C.
        Stimulation by 1,25-dihydroxyvitamin D3 of insulin receptor expression and insulin responsiveness for glucose transport in U-937 human promonocytic cells.
        Endocr J. 2000; 47: 383-391
        • Karvonen M.
        • Jantti V.
        • Muntoni S.
        • Stabilini M.
        • Stabilini L.
        • Tuomilehto J.
        Comparison of the seasonal pattern in the clinical onset of IDDM in Finland and Sardinia.
        Diabetes Care. 1998; 21: 1101-1109
        • Mohr S.B.
        • Garland C.F.
        • Gorham E.D.
        • Garland F.C.
        The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide.
        Diabetologia. 2008; 51: 1391-1398
        • The EURODIAB Substudy 2 Study Group
        Vitamin D supplement in early childhood and risk for Type I (insulin-dependent) diabetes mellitus.
        Diabetologia. 1999; 42: 51-54
        • Ishii H.
        • Suzuki H.
        • Baba T.
        • Nakamura K.
        • Watanabe T.
        Seasonal variation of glycemic control in type 2 diabetic patients.
        Diabetes Care. 2001; 24: 1503
        • Borissova A.M.
        • Tankova T.
        • Kirilov G.
        • Dakovska L.
        • Kovacheva R.
        The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients.
        Int J Clin Pract. 2003; 57: 258-261
        • Chiu K.C.
        • Chu A.
        • Go V.L.
        • Saad M.F.
        Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction.
        Am J Clin Nutr. 2004; 79: 820-825
        • Schwalfenberg G.
        Vitamin D and diabetes: improvement of glycemic control with vitamin D3 repletion.
        Can Fam Physician. 2008; 54: 864-866
        • Martini L.A.
        • Wood R.J.
        Vitamin D status and the metabolic syndrome.
        Nutr Rev. 2006; 64: 479-486
        • Fliser D.
        • Stefanski A.
        • Franek E.
        • Fode P.
        • Gudarzi A.
        • Ritz E.
        No effect of calcitriol on insulin-mediated glucose uptake in healthy subjects.
        Eur J Clin Invest. 1997; 27: 629-633
        • Tai K.
        • Need A.G.
        • Horowitz M.
        • Chapman I.M.
        Glucose tolerance and vitamin D: effects of treating vitamin D deficiency.
        Nutrition. 2008; 24: 950-956
        • Dilmec F.
        • Uzer E.
        • Akkafa F.
        • Kose E.
        • van Kuilenburg A.B.
        Detection of VDR gene ApaI and TaqI polymorphisms in patients with type 2 diabetes mellitus using PCR-RFLP method in a Turkish population.
        J Diabetes Complications. 2009; 24: 186-191
        • Malecki M.T.
        • Frey J.
        • Moczulski D.
        • Klupa T.
        • Kozek E.
        • Sieradzki J.
        Vitamin D receptor gene polymorphisms and association with type 2 diabetes mellitus in a Polish population.
        Exp Clin Endocrinol Diabetes. 2003; 111: 505-509
        • Bid H.K.
        • Konwar R.
        • Aggarwal C.G.
        • Gautam S.
        • Saxena M.
        • Nayak V.L.
        • Banerjee M.
        Vitamin D receptor (FokI, BsmI and TaqI) gene polymorphisms and type 2 diabetes mellitus: a North Indian study.
        Indian J Med Sci. 2009; 63: 187-194
        • Danescu L.G.
        • Levy S.
        • Levy J.
        Vitamin D and diabetes mellitus.
        Endocrine. 2009; 35: 11-17
        • Lind L.
        • Hanni A.
        • Lithell H.
        • Hvarfner A.
        • Sorensen O.H.
        • Ljunghall S.
        Vitamin D is related to blood pressure and other cardiovascular risk factors in middle-aged men.
        Am J Hypertens. 1995; 8: 894-901
        • Heikkinen A.M.
        • Tuppurainen M.T.
        • Niskanen L.
        • Komulainen M.
        • Penttila I.
        • Saarikoski S.
        Long-term vitamin D3 supplementation may have adverse effects on serum lipids during postmenopausal hormone replacement therapy.
        Eur J Endocrinol. 1997; 137: 495-502
        • Montagnani M.
        • Lore F.
        • Di Cairano G.
        • Gonnelli S.
        • Ciuoli C.
        • Montagnani A.
        • Gennari C.
        Effects of pravastatin treatment on vitamin D metabolites.
        Clin Ther. 1994; 16: 824-829
        • Perez-Castrillon J.L.
        • Vega G.
        • Abad L.
        • Sanz A.
        • Chaves J.
        • Hernandez G.
        • Duenas A.
        Effects of atorvastatin on vitamin D levels in patients with acute ischemic heart disease.
        Am J Cardiol. 2007; 99: 903-905
        • Wilczek H.
        • Sobra J.
        • Ceska R.
        • Justova V.
        • Juzova Z.
        • Prochazkova R.
        • Kvasilova M.
        Monitoring plasma levels of vitamin D metabolites in simvastatin (Zocor) therapy in patients with familial hypercholesterolemia [article in Czech].
        Cas Lek Cesk. 1994; 133: 727-729
        • Yavuz B.
        • Ertugrul D.T.
        • Cil H.
        • Ata N.
        • Akin K.O.
        • Yalcin A.A.
        • Kucukazman M.
        • Dal K.
        • Hokkaomeroglu M.S.
        • Yavuz B.B.
        • Tutal E.
        Increased levels of 25 hydroxyvitamin D and 1,25-dihydroxyvitamin D after rosuvastatin treatment: a novel pleiotropic effect of statins?.
        Cardiovasc Drugs Ther. 2009; 23: 295-299
        • Guryev O.
        • Carvalho R.A.
        • Usanov S.
        • Gilep A.
        • Estabrook R.W.
        A pathway for the metabolism of vitamin D3: unique hydroxylated metabolites formed during catalysis with cytochrome P450scc (CYP11A1).
        Proc Natl Acad Sci U S A. 2003; 100: 14754-14759
        • Oh J.
        • Weng S.
        • Felton S.K.
        • Bhandare S.
        • Riek A.
        • Butler B.
        • Proctor B.M.
        • Petty M.
        • Chen Z.
        • Schechtman K.B.
        • Bernal-Mizrachi L.
        • Bernal-Mizrachi C.
        1,25(OH)2 vitamin d inhibits foam cell formation and suppresses macrophage cholesterol uptake in patients with type 2 diabetes mellitus.
        Circulation. 2009; 120: 687-698
        • Zittermann A.
        • Fischer J.
        • Schleithoff S.S.
        • Tenderich G.
        • Fuchs U.
        • Koerfer R.
        Patients with congestive heart failure and healthy controls differ in vitamin D-associated lifestyle factors.
        Int J Vitam Nutr Res. 2007; 77: 280-288
        • Watson K.E.
        • Abrolat M.L.
        • Malone L.L.
        • Hoeg J.M.
        • Doherty T.
        • Detrano R.
        • Demer L.L.
        Active serum vitamin D levels are inversely correlated with coronary calcification.
        Circulation. 1997; 96: 1755-1760
        • Fleck A.
        Latitude and ischaemic heart disease.
        Lancet. 1989; 1: 613
        • Kendrick J.
        • Targher G.
        • Smits G.
        • Chonchol M.
        25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey.
        Atherosclerosis. 2009; 205: 255-260
        • Melamed M.L.
        • Michos E.D.
        • Post W.
        • Astor B.
        25-hydroxyvitamin D levels and the risk of mortality in the general population.
        Arch Intern Med. 2008; 168: 1629-1637
        • Wolf M.
        • Shah A.
        • Gutierrez O.
        • Ankers E.
        • Monroy M.
        • Tamez H.
        • Steele D.
        • Chang Y.
        • Camargo Jr, C.A.
        • Tonelli M.
        • Thadhani R.
        Vitamin D levels and early mortality among incident hemodialysis patients.
        Kidney Int. 2007; 72: 1004-1013
        • Giovannucci E.
        • Liu Y.
        • Hollis B.W.
        • Rimm E.B.
        25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study.
        Arch Intern Med. 2008; 168: 1174-1180
        • Wang T.J.
        • Pencina M.J.
        • Booth S.L.
        • Jacques P.F.
        • Ingelsson E.
        • Lanier K.
        • Benjamin E.J.
        • D'Agostino R.B.
        • Wolf M.
        • Vasan R.S.
        Vitamin D deficiency and risk of cardiovascular disease.
        Circulation. 2008; 117: 503-511
        • Pilz S.
        • Dobnig H.
        • Fischer J.E.
        • Wellnitz B.
        • Seelhorst U.
        • Boehm B.O.
        • Marz W.
        Low vitamin d levels predict stroke in patients referred to coronary angiography.
        Stroke. 2008; 39: 2611-2613
        • Pilz S.
        • Marz W.
        • Wellnitz B.
        • Seelhorst U.
        • Fahrleitner-Pammer A.
        • Dimai H.P.
        • Boehm B.O.
        • Dobnig H.
        Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography.
        J Clin Endocrinol Metab. 2008; 93: 3927-3935
        • LaCroix A.Z.
        • Kotchen J.
        • Anderson G.
        • Brzyski R.
        • Cauley J.A.
        • Cummings S.R.
        • Gass M.
        • Johnson K.C.
        • Ko M.
        • Larson J.
        • Manson J.E.
        • Stefanick M.L.
        • Wactawski-Wende J.
        Calcium plus vitamin D supplementation and mortality in postmenopausal women: the Women's Health Initiative calcium-vitamin D randomized controlled trial.
        J Gerontol A Biol Sci Med Sci. 2009; 64: 559-567
        • Trivedi D.P.
        • Doll R.
        • Khaw K.T.
        Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial.
        BMJ. 2003; 326: 469
        • Tishkoff D.X.
        • Nibbelink K.A.
        • Holmberg K.H.
        • Dandu L.
        • Simpson R.U.
        Functional vitamin D receptor (VDR) in the t-tubules of cardiac myocytes: VDR knockout cardiomyocyte contractility.
        Endocrinology. 2008; 149: 558-564
        • Weishaar R.E.
        • Kim S.N.
        • Saunders D.E.
        • Simpson R.U.
        Involvement of vitamin D3 with cardiovascular function.
        Am J Physiol. 1990; 258: E134-E142
        • Szabó B.
        • Merkely B.
        • Takács I.
        The role of vitamin D in the development of cardiac failure [article in Hungarian].
        Orv Hetil. 2009; 150: 1397-1402
        • McGonigle R.J.
        • Fowler M.B.
        • Timmis A.B.
        • Weston M.J.
        • Parsons V.
        Uremic cardiomyopathy: potential role of vitamin D and parathyroid hormone.
        Nephron. 1984; 36: 94-100
        • Shane E.
        • Mancini D.
        • Aaronson K.
        • Silverberg S.J.
        • Seibel M.J.
        • Addesso V.
        • McMahon D.J.
        Bone mass, vitamin D deficiency, and hyperparathyroidism in congestive heart failure.
        Am J Med. 1997; 103: 197-207
        • Bahrami H.
        • Kronmal R.
        • Bluemke D.A.
        • Olson J.
        • Shea S.
        • Liu K.
        • Burke G.L.
        • Lima J.A.
        Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis.
        Arch Intern Med. 2008; 168: 2138-2145
        • Laguardia S.P.
        • Dockery B.K.
        • Bhattacharya S.K.
        • Nelson M.D.
        • Carbone L.D.
        • Weber K.T.
        Secondary hyperparathyroidism and hypovitaminosis D in African-Americans with decompensated heart failure.
        Am J Med Sci. 2006; 332: 112-118
        • Coughlin S.S.
        • Myers L.
        • Michaels R.K.
        What explains black-white differences in survival in idiopathic dilated cardiomyopathy?.
        J Natl Med Assoc. 1997; 89: 277-282
        • Dries D.L.
        • Exner D.V.
        • Gersh B.J.
        • Cooper H.A.
        • Carson P.E.
        • Domanski M.J.
        Racial differences in the outcome of left ventricular dysfunction.
        N Engl J Med. 1999; 340: 609-616
        • Vaccarino V.
        • Gahbauer E.
        • Kasl S.V.
        • Charpentier P.A.
        • Acampora D.
        • Krumholz H.M.
        Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans.
        Am Heart J. 2002; 143: 1058-1067
        • Reusser M.E.
        • DiRienzo D.B.
        • Miller G.D.
        • McCarron D.A.
        Adequate nutrient intake can reduce cardiovascular disease risk in African Americans.
        J Natl Med Assoc. 2003; 95: 188-195
        • Hagstrom E.
        • Hellman P.
        • Larsson T.E.
        • Ingelsson E.
        • Berglund L.
        • Sundstrom J.
        • Melhus H.
        • Held C.
        • Lind L.
        • Michaelsson K.
        • Arnlov J.
        Plasma parathyroid hormone and the risk of cardiovascular mortality in the community.
        Circulation. 2009; 119: 2765-2771
        • Luboshitzky R.
        • Chertok-Schaham Y.
        • Lavi I.
        • Ishay A.
        Cardiovascular risk factors in primary hyperparathyroidism.
        J Endocrinol Invest. 2009; 32: 317-321
      1. Yu N, T PD, Flynn Robert WV, Michael JM, Smith D, Rudman A, Graham PL. Increased mortality and morbidity in mild primary hyperparathyroid patients. Clin Endocrinol (Oxf). In press.

        • Bell N.H.
        • Epstein S.
        • Greene A.
        • Shary J.
        • Oexmann M.J.
        • Shaw S.
        Evidence for alteration of the vitamin D-endocrine system in obese subjects.
        J Clin Invest. 1985; 76: 370-373
        • Alsafwah S.
        • Laguardia S.P.
        • Nelson M.D.
        • Battin D.L.
        • Newman K.P.
        • Carbone L.D.
        • Weber K.T.
        Hypovitaminosis D in African Americans residing in Memphis, Tennessee with and without heart failure.
        Am J Med Sci. 2008; 335: 292-297
        • Nesby-O'Dell S.
        • Scanlon K.S.
        • Cogswell M.E.
        • Gillespie C.
        • Hollis B.W.
        • Looker A.C.
        • Allen C.
        • Doughertly C.
        • Gunter E.W.
        • Bowman B.A.
        Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: Third National Health and Nutrition Examination Survey, 1988–1994.
        Am J Clin Nutr. 2002; 76: 187-192
        • Wolf M.
        • Betancourt J.
        • Chang Y.
        • Shah A.
        • Teng M.
        • Tamez H.
        • Gutierrez O.
        • Camargo Jr, C.A.
        • Melamed M.
        • Norris K.
        • Stampfer M.J.
        • Powe N.R.
        • Thadhani R.
        Impact of activated vitamin D and race on survival among hemodialysis patients.
        J Am Soc Nephrol. 2008; 19: 1379-1388
        • Zittermann A.
        • Schleithoff S.S.
        • Gotting C.
        • Dronow O.
        • Fuchs U.
        • Kuhn J.
        • Kleesiek K.
        • Tenderich G.
        • Koerfer R.
        Poor outcome in end-stage heart failure patients with low circulating calcitriol levels.
        Eur J Heart Fail. 2008; 10: 321-327
        • Testa A.
        • Mallamaci F.
        • Benedetto F.
        • Pisano A.
        • Tripepi G.
        • Malatino L.
        • Thadhani R.
        • Zoccali C.
        Vitamin D receptor (VDR) gene polymorphism is associated with left ventricular (LV) mass and predicts LVH progression in end stage renal disease (ESRD) patients.
        J Bone Miner Res. 2009; 25: 313-319
        • Park C.W.
        • Oh Y.S.
        • Shin Y.S.
        • Kim C.M.
        • Kim Y.S.
        • Kim S.Y.
        • Choi E.J.
        • Chang Y.S.
        • Bang B.K.
        Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism.
        Am J Kidney Dis. 1999; 33: 73-81
        • Schleithoff S.S.
        • Zittermann A.
        • Tenderich G.
        • Berthold H.K.
        • Stehle P.
        • Koerfer R.
        Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial.
        Am J Clin Nutr. 2006; 83: 754-759
        • Chavan C.B.
        • Sharada K.
        • Rao H.B.
        • Narsimhan C.
        Hypocalcemia as a cause of reversible cardiomyopathy with ventricular tachycardia.
        Ann Intern Med. 2007; 146: 541-542
        • Vintzileos A.M.
        • Neckles S.
        • Campbell W.A.
        • Andreoli Jr, J.W.
        • Kaplan B.M.
        • Nochimson D.J.
        Three fetal ponderal indexes in normal pregnancy.
        Obstet Gynecol. 1985; 65: 807-811
        • Sood S.
        • Reghunandanan R.
        • Reghunandanan V.
        • Gopinathan K.
        • Sood A.K.
        Effect of vitamin D deficiency on electrocardiogram of rats.
        Indian J Exp Biol. 1995; 33: 61-63
        • Autier P.
        • Gandini S.
        Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials.
        Arch Intern Med. 2007; 167: 1730-1737