Hindawi Publishing Corporation, Journal of Diabetes Research, Volume 2013, Article ID 243934,10 pages
Department of Endocrinology, Shanghai Pudong Hospital, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai 201399, China Correspondence should be addressed to Chaoxun Wang; xunshdonger at hotmail.com Received 23 November 2012; Revised 9 January 2013; Accepted 9 January 2013 Academic Editor: T. S. Kern
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.
2. Biosynthesis of Vitamin D
3. Vitamin D Receptor
4. Vitamin D Deficiency
5. Extraskeletal Role of Vitamin D
6. Cardiometabolic Consequences of Vitamin D Deficiency
7. Vitamin D Deficiency and Hypertension
8. Vitamin D Deficiency and CVD Risk
9. Vitamin D Deficiency and Heart Failure
10. Vitamin D Deficiency and Diabetes
11. Vitamin D Deficiency and Metabolic Syndrome
12. Vitamin D Deficiency and Complications of Diabetes
Vitamin D deficiency (VDD) has been classically associated with decreased bone health.However,growing body of evidence has accumulated to suggest beyond doubt that the manifestations of VDD reach well beyond the skeletal system; this is very much apparent by simply observing the wide range of distribution of the vitamin D receptor (VDR).
The role of VDD, along with clinical evidence, in causing and/or aggravating various cardiometabolic disease conditions including hypertension, cardiovascular disease risk, diabetes and its complications such as neuropathy, nephropathy, and diabetic fractures, and metabolic syndrome has been discussed in detail. Despite the presence of numerous studies, both animal and human, the precise role of vitamin D in various cardiometabolic diseases is still a blur. It has been apparent from this paper that in many situations, the results from animal studies, observational studies, and RCTs seem to diverge. Further, in many situations, it is just an observation that VDD and a condition coexist; it is not clear whether the VDD is the cause or the consequence of the condition in question. It might also be possible that vitamin D is not causally related to any health condition but is simply a marker of a general well being and good health. Thus, to clarify the exact role of VDD, good-quality, large, well-designed, and conducted RCTs are still required.
Finally, when it comes to supplementation with vitamin D, to date, the question addressed by intervention studies has been primarily whether vitamin D supplementation may be effective for either the treatment or prevention of various conditions. However, it is important to recognize that all the recommendations regarding vitamin D supplementation have been made keeping in mind the role of vitamin D in bone health.Thus,it is the need of the hour to formulate new guidelines for supplementation with vitamin D, keeping in mind these extraskeletal manifestations of VDD and the potential for the enormous public health improvement that such a guideline may actually bring upon.Till such guidelines are published, it is pertinent to bear in mind the importance of maintaining adequate serum concentrations of vitamin D by means of a dequate nutrition and, when indicated or required, supplementation in patients at risk of developing cardiometabolic disorders, in order to achieve better treatment results and improved morbidity and health.
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CLIN PEDIATR March 2013 vol. 52 no. 3 210-223
Diana H. Dolinsky, MD, MPH1
Sarah Armstrong, MD 1 sarah.c.armstrong at dm.duke.edu
Caren Mangarelli, MD1
Alex R. Kemper, MD, MPH, MS1
1 Duke University Medical Center, Durham, NC, USA
The objective of this systematic review was to evaluate the association between serum 25-hydroxyvitamin D (25OHD) and cardiometabolic risk in children and the effect of vitamin D supplementation on risk. We included 35 clinical trials, cross-sectional studies, case-control studies, and cohort studies that evaluated the relationship between 25OHD and blood pressure, lipid levels, insulin/glucose metabolism, endothelial dysfunction, and arterial stiffness.
One randomized clinical trial that randomized adolescents to 2000 or 400 IU/d of vitamin D and found improvement in arterial stiffness in the high-dose group and worsening in the low-dose group.
One cross-sectional study found no relationship between 25OHD and endothelial dysfunction.
Of 12 cross-sectional studies, 10 found an inverse association between 25OHD and systolic blood pressure, although 2 trials found no relationship.
There was no consistent association between 25OHD and lipid levels or insulin/glucose metabolism.
Insufficient evidence was available to conclude that vitamin D supplementation yields cardiometabolic benefit.