Vitamin D, cardiovascular disease and mortality

Authors

  • Stefan Pilz,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria,
    2. Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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  • Andreas Tomaschitz,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria,
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  • Winfried März,

    1. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
    2. Mannheim Institute of Public Health, Ruperto Carola University Heidelberg, Medical Faculty Mannheim, Mannheim
    3. Synlab Center of Laboratory Diagnostics, Heidelberg
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  • Christiane Drechsler,

    1. Division of Nephrology, Department of Medicine, University of Würzburg, Würzburg
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  • Eberhard Ritz,

    1. Department of Nephrology, University of Heidelberg, Heidelberg
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  • Armin Zittermann,

    1. Clinic for Thoracic and Cardiovascular Surgery, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
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  • Etienne Cavalier,

    1. Department of Clinical Chemistry, University of Liege, CHU Sart-Tilman, Liege, Belgium
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  • Thomas R. Pieber,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria,
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  • Joan M. Lappe,

    1. Osteoporosis Research Center, Creighton University Medical Center, Omaha, NE
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  • William B. Grant,

    1. Sunlight, Nutrition, and Health Research Center, San Francisco, CA
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  • Michael F. Holick,

    1. Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston, MA, USA
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  • Jacqueline M. Dekker

    1. Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Stefan Pilz, Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. Tel.: +43 650 9103667; Fax: +43 316 673216; E-mail: stefan.pilz@chello.at

Summary

A poor vitamin D status, i.e. low serum levels of 25-hydroxyvitamin D [25(OH)D], is common in the general population. This finding is of concern not only because of the classic vitamin D effects on musculoskeletal outcomes, but also because expression of the vitamin D receptor (VDR) and vitamin D metabolizing enzymes in the heart and blood vessels suggests a role of vitamin D in the cardiovascular system. VDR-knockout mice suffer from cardiovascular disease (CVD), and various experimental studies suggest cardiovascular protection by vitamin D, including antiatherosclerotic, anti-inflammatory and direct cardio-protective actions, beneficial effects on classic cardiovascular risk factors as well as suppression of parathyroid hormone (PTH) levels. In epidemiological studies, low levels of 25(OH)D are associated with increased risk of CVD and mortality. Data from randomized controlled trials (RCTs) are sparse and have partially, but not consistently, shown some beneficial effects of vitamin D supplementation on cardiovascular risk factors (e.g. arterial hypertension). We have insufficient data on vitamin D effects on cardiovascular events, but meta-analyses of RCTs indicate that vitamin D may modestly reduce all-cause mortality. Despite accumulating data suggesting that a sufficient vitamin D status may protect against CVD, we still must wait for results of large-scale RCTs before raising general recommendations for vitamin D in the prevention and treatment of CVD. In current clinical practice, the overall risks and costs of vitamin D supplementation should be weighed against the potential adverse consequences of untreated vitamin D deficiency.

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