Vitamin D Deficiency and Cardiovascular Health
Vitamin D Deficiency and Cardiovascular Health
Abstract & Commentary
By Harold L. Karpman, MD, FACC, FACP, Clinical Professor of Medicine, UCLA School of Medicine. Dr. Karpman reports no financial relationships relevant to this field of study.
Synopsis: Vitamin D deficiency is associated with a significant risk of cardiovascular disease and reduced survival. Vitamin D supplementation improved survival, especially in patients with documented deficiency.
Source: Vacek JL, et al. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol 2012;109:359-363.
It is well known that cardiovascular disease is the most common cause of mortality and morbidity, accounting for nearly 30% of all deaths worldwide in 2003. In addition to its well-defined role in bone and calcium metabolism, vitamin D deficiency has been identified as an important factor in cardiovascular health. In fact, recent published reports have highlighted the presence of significant vitamin D deficiency in subjects with hypertension, peripheral vascular disease, diabetes mellitus, the metabolic syndrome, coronary artery disease, and heart failure. In a recently reported 20 hospital multicenter study, almost all patients entering with an acute myocardial infarction were found to have abnormally low vitamin D levels.1
Vacek and his associates examined the relationship between vitamin D deficiency, vitamin D supplementation, and patient outcomes in a large cohort. Vitamin D measurements were observed over a 5-year and 8-month period of time in 10,899 patients. The vitamin D deficiency observed in 7665 of these patients was associated with several cardiovascular-related illnesses, including hypertension, coronary artery disease, cardiomyopathy, and diabetes, and it was a strong independent predictor of all cause mortality. In addition, vitamin D supplementation was associated with a significantly improved survival rate, particularly in those patients with a documented deficiency.2
This observational, retrospective study2 using a cohort of patients followed by a cardiovascular practice in a large academic medical center demonstrated a clear association between vitamin D deficiency and many cardiovascular disease states, including hypertension,3-5 coronary artery disease,6-7 cardiomyopathy,6 and multiple cardiovascular risk factors including hypertension, diabetes mellitus, and hyperlipidemia. Multiple prior studies have suggested that vitamin D deficiency was associated with poor patient outcomes8-9 and, equally important, the Vacek study2 is one of the first papers to demonstrate better survival with vitamin D supplementation. However, additional investigation with long-term prospective studies of various vitamin D dosage levels in both healthy and vitamin D-deficient populations are indicated to firmly establish the role of vitamin D supplementation on overall outcomes and mortality. Patient compliance, dose and duration of vitamin D supplementation, and outcomes will all have to be carefully analyzed in a well-designed prospective study in various patient populations. While waiting for the results of these important studies, clinicians should consider treating most, if not all, of their vitamin D-deficient patients with 1000-2000 IU of vitamin D daily until their vitamin D levels reach normal values.
1. Lee JH, et al. Prevalence of vitamin D deficiency in patients with acute myocardial infarction. Am J Cardiol 2011;107:1636-1638.
2. Vacek JL, et al. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol 2012;109:359-363.
3. Scragg R, et al. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens 2007; 20:713-719.
4. Snijder MB, et al. 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.
5. Forman JP, et al. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension among young women. Hypertension 2008;52:828-832.
6. Kim DH, et al. 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.
7. Giovannucci E, et al. 25-hydroxyvitamin D and risk of myocardial infarction in men: A prospective study. Arch Intern Med 2008;168:1174-1180.
8. Michaelsson K, et al. Plasma vitamin D and mortality in older men: A community-based prospective cohort study. Am J Clin Nutr 2010;4:841-848.
9. Pilz S, et al. Vitamin D and mortality in older men and women. Clin Endocrinol Oxf 2009;71:666-672.Vitamin D deficiency is associated with a significant risk of cardiovascular disease and reduced survival. Vitamin D supplementation improved survival, especially in patients with documented deficiency.
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