title: Vitamin D and cardiovascular disease: is the evidence solid?
abstract: Vitamin D deficiency, prevalent in 30-50% of adults in developed countries, is largely due to inadequate cutaneous production that results from decreased exposure to sunlight, and to a lesser degree from low dietary intake of vitamin D. Serum levels of 25-hydroxyvitamin D (25-OH D) <20 ng/mL indicate vitamin D deficiency and levels >30 ng/mL are considered optimal. While the endocrine functions of vitamin D related to bone metabolism and mineral ion homoeostasis have been extensively studied, robust epidemiological evidence also suggests a close association between vitamin D deficiency and cardiovascular morbidity and mortality. Experimental studies have demonstrated novel actions of vitamin D metabolites on cardiomyocytes, and endothelial and vascular smooth muscle cells. Low 25-OH D levels are associated with left ventricular hypertrophy, vascular dysfunction, and renin-angiotensin system activation. Despite a large body of experimental, cross-sectional, and prospective evidence implicating vitamin D deficiency in the pathogenesis of cardiovascular disease, a causal relationship remains to be established. Moreover, the cardiovascular benefits of normalizing 25-OH D levels in those without renal disease or hyperparathyroidism have not been established, and questions of an epiphenomenon where vitamin D status merely reflects a classic risk burden have been raised. Randomized trials of vitamin D replacement employing cardiovascular endpoints will provide much needed evidence for determining its role in cardiovascular protection.
authors.affiliation: Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road, Suite-D403C, Atlanta, GA 30322, USA.
authors.forename: Ibhar
authors.initials: I
authors.lastname: Al Mheid
authors.forename: Riyaz S
authors.initials: RS
authors.lastname: Patel
authors.forename: Vin
authors.initials: V
authors.lastname: Tangpricha
authors.forename: Arshed A
authors.initials: AA
authors.lastname: Quyyumi
mesh_terms: D056704:Adaptive Immunity / Q000502:physiology; D000818:Animals; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000209:etiology* / Q000517:prevention & control; D019587:Dietary Supplements; D042783:Endothelial Cells / Q000502:physiology; D006801:Humans; D032383:Myocytes, Cardiac / Q000502:physiology; D051381:Rats; D018167:Receptors, Calcitriol / Q000502:physiology; D012084:Renin-Angiotensin System / Q000502:physiology; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000096:biosynthesis / Q000097:blood / Q000502:physiology* / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications*; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D018167:Receptors, Calcitriol; D014815:Vitamins; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Cardiovascular disease; Vascular risk factors; Vitamin D