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Vitamin D Deficiency and Supplementation and Relation to Cardiovascular Health

Published:November 10, 2011DOI:https://doi.org/10.1016/j.amjcard.2011.09.020
      Recent evidence supports an association between vitamin D deficiency and hypertension, peripheral vascular disease, diabetes mellitus, metabolic syndrome, coronary artery disease, and heart failure. The effect of vitamin D supplementation, however, has not been well studied. We examined the associations between vitamin D deficiency, vitamin D supplementation, and patient outcomes in a large cohort. Serum vitamin D measurements for 5 years and 8 months from a large academic institution were matched to patient demographic, physiologic, and disease variables. The vitamin D levels were analyzed as a continuous variable and as normal (≥30 ng/ml) or deficient (<30 ng/ml). Descriptive statistics, univariate analysis, multivariate analysis, survival analysis, and Cox proportional hazard modeling were performed. Of 10,899 patients, the mean age was 58 ± 15 years, 71% were women (n = 7,758), and the average body mass index was 30 ± 8 kg/m2. The mean serum vitamin D level was 24.1 ± 13.6 ng/ml. Of the 10,899 patients, 3,294 (29.7%) were in the normal vitamin D range and 7,665 (70.3%) were deficient. Vitamin D deficiency was associated with several cardiovascular-related diseases, including hypertension, coronary artery disease, cardiomyopathy, and diabetes (all p <0.05). Vitamin D deficiency was a strong independent predictor of all-cause death (odds ratios 2.64, 95% confidence interval 1.901 to 3.662, p <0.0001) after adjusting for multiple clinical variables. Vitamin D supplementation conferred substantial survival benefit (odds ratio for death 0.39, 95% confidence interval 0.277 to 0.534, p <0.0001). In conclusion, vitamin D deficiency was associated with a significant risk of cardiovascular disease and reduced survival. Vitamin D supplementation was significantly associated with better survival, specifically in patients with documented deficiency.
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      References

        • 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
        • DeLuca H.F.
        Overview of general physiologic features and functions of vitamin D.
        Am J Clin Nutr. 2004; 80: 1689S-1696S
        • 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
        • 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
        • 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
        • 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
        • Autier P.
        • Gandini S.
        Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials.
        Arch Intern Med. 2007; 167: 1730-1737
        • Lee P.
        • Greenfield J.R.
        • Seibel M.J.
        • Eisman J.A.
        • Center J.R.
        Adequacy of vitamin D supplementation in severe deficiency is dependent on body mass index.
        Am J Med. 2009; 122: 1056-1060
        • 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
        • Wortsman J.
        • Matsuoka L.Y.
        • Chen T.C.
        • Lu Z.
        • Holick M.F.
        Decreased bioavailability of vitamin D in obesity.
        Am J Clin Nutr. 2000; 72: 690-693
        • Arunabh S.
        • Pollack S.
        • Yeh J.
        • Aloia J.F.
        Body fat content and 25-hydroxyvitamin D levels in healthy women.
        J Clin Endocrinol Metab. 2003; 88: 157-161
        • 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
        • 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
        • 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
        • Ramagopalan S.V.
        • Heger A.
        • Berlanga A.J.
        • Maugeri N.J.
        • Lincoln M.R.
        • Burrell A.
        • Handunnetthi L.
        • Handel A.E.
        • Disanto G.
        • Orton S.M.
        • Watson C.T.
        • Morahan J.M.
        • Giovannoni G.
        • Ponting C.P.
        • Ebers G.C.
        • Knight J.C.
        A ChIP-seq defined genome-wide map of vitamin D receptor binding: Associations with disease and evolution.
        Genome Res. 2010; 10: 1352-1360
        • 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
        • 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
        • Snijder M.B.
        • Lips P.
        • Seidell J.C.
        • Visser M.
        • Deeg D.J.
        • Dekker J.M.
        • van Dam R.M.
        Vitamin D status and parathyroid hormone levels in relation to blood pressure: a population-based study in older men and women.
        J Intern Med. 2007; 261: 558-565
        • Forman J.P.
        • Curhan G.C.
        • Taylor E.N.
        Plasma 25-hydroxyvitamin D levels and risk of incident hypertension among young women.
        Hypertension. 2008; 52: 828-832
        • 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
        • 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
        • Michaelsson K.
        • Baron J.A.
        • Snellman G.
        • Gedeborg R.
        • Byberg L.
        • Sundstrom J.
        • Berglund L.
        • Arnlov J.
        • Hellman P.
        • Blomhoff R.
        • Wolk A.
        • Garmo H.
        • Holmberg L.
        • Melhus H.
        Plasma vitamin D and mortality in older men: a community-based prospective cohort study.
        Am J Clin Nutr. 2010; 4: 841-848
        • Joergensen C.
        • Gall M.A.
        • Schmedes A.
        • Tarnow L.
        • Parving H.H.
        • Rossing P.
        Vitamin D levels and mortality in type 2 diabetes.
        Diabetes Care. 2010; 10: 2238-2243
        • Pilz S.
        • Dobnig H.
        • Nijpels G.
        • Heine R.J.
        • Stehouwer C.D.
        • Snijder M.B.
        • van Dam R.M.
        • Dekker J.M.
        Vitamin D and mortality in older men and women.
        Clin Endocrinol Oxf. 2009; 71: 666-672
        • 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
        • Holick M.F.
        • Binkley N.C.
        • Bischoff-Ferrari H.A.
        • Gordon C.M.
        • Hanley D.A.
        • Heaney R.P.
        • Murad M.H.
        • Weaver C.M.
        • Endocrine Society
        Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline.
        J Clin Endocrinol Metab. 2011; 96: 1911-1930