Clin Endocrinol (Oxf). 2011 Jun 17. doi: 10.1111/j.1365-2265.2011.04147.x.
Pilz S, Tomaschitz A, März W, Drechsler C, Ritz E, Zittermann A, Cavalier E, Pieber TR, Lappe JM, Grant WB, Holick MF, Dekker JM.
Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria Mannheim Institute of Public Health, Ruperto Carola University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany Synlab Center of Laboratory Diagnostics, Heidelberg, Germany Department of Medicine, Division of Nephrology, University of Würzburg, Würzburg, Germany Department of Nephrology, University of Heidelberg, Heidelberg, Germany Clinic for Thoracic and Cardiovascular Surgery, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany Department of Clinical Chemistry, University of Liege, CHU Sart-Tilman, Liege, Belgium
Osteoporosis Research Center, Creighton University Medical Center, Omaha, Nebraska, USA
Sunlight, Nutrition, and Health Research Center, San Francisco, California, USA Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston, Massachusetts, USA.
A poor vitamin D status, i.e. low serum levels of 25-hydroxyvitamin D (25OHD), 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 anti-atherosclerotic, 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.
Copyright © 2011 Blackwell Publishing Ltd.
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