vitamin d and cardiovascular disease where do we stand in 2017 ?
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Schematic representation of the biosynthesis of vitamin D.
Vitamin D is photosynthesized in the skin and is also acquired by dietary intake. Two hydroxylation steps in the liver and the kidney are required for vitamin D activation,
thus forming 1,25-dihydroxyvitamin D.
Storage form Active form(Hormone)
VDRE (promoter region of target genes)
Vitamin D receptor (VDR) binds retinoid X receptor (RXR) at the vitamin D receptor element (VDRE) to regulate gene expression.
vitamin D deficiency and/or VDR gene deletion affects the heart, vasculature, and immune system, which may, in turn, contribute to the development of heart failure, hypertension, and increased atherosclerosis.
Decreased VDR Activation
1,25 VD3 binds to the VDR, which then combines with RXR to activate gene
∗Treatment with vitamin D3 or D2. †Including recommended daily allowance. 25-OH D = 25-hydroxyvitamin D.
Categories of Vitamin D Status According to the Institute of Medicine Versus the Endocrine Society
Current Vitamin D GuidelinesSummary of guidelines regarding vitamin D deficiency
screening and supplementation
Note that all threshold and treatment values are to promote optimal serum 25-hydroxyvitamin D levels for bone health, and not the prevention of cardiovascular disease .
a IOM is a US organization, but the IOM Vitamin D report was funded by the US and Canadian governments .b The Endocrine Society recognizes that supplementation up to 10,000 IU/day in people aged 19 years and older may be needed to correct for deficiency .c Risk factors for deficiency include: African-American and Hispanic ethnicity, pregnant or lactating women, older adults with history of falls or fractures, obesity (BMI >30 kg/m2 ), malabsorption syndromes, chronic kidney disease, liver failure, conditions that cause weakening of bone, certain medications including anticonvulsants
Vitamin D and the Heart
Do lower vitamin D levels mean higher risk for cardiovascular disease?
Is Vitamin D a New Therapeutic Option in Coronary Artery Disease?
Do lower vitamin D levels mean higher risk for cardiovascular disease?
A Novel Biomarker for Cardiovascular Disease?
Proposed mechanisms by which vitamin D deficiency and highcalcium levels (typically
from calcium supplementation and not dietary calcium sources)
may increase cardiovascular disease risk.
RAAS, reninangiotensin-aldosterone system; VSMC, vascular smooth muscle cell; LV,left ventricular
The vitamin D-dependent parathyroid hormone is considered as the possible actuator of vitamin D effects on cardiovascular risk
(Vitamin D deficiency : A possible driver of T2D)
Published 2 November 2017
In cardiac patients with diabetes, the higher number of stenoticcoronary arteries is associated with lower values of the 25(OH)D.
A group of male cardiac patients with diabetes with significant stenosis in three coronary arteries, hospitalized due to acute coronary syndrome, with a history of previous MI and hyperlipidemia presented the lowest vitamin D level.
Is vitamin D deficiency a risk factor for severe coronary artery disease and acute coronary syndrome?
In this recent article, Lee et al. concluded that participants with coronary artery plaques are likely
to have relatively low vitamin D level. They added some evidence that vitamin D status is
associated with atherosclerosis.
2017
Proposed models for the association of biomarkers of vitamin D status with risk of coronary disease.
This study adds to the growing literature indicating that biomarkers of vitamin D status beyond 25(OH)D may have an independent role in cardiovascular disease.
25-hydroxyvitamin D
parathyroid hormone
vitamin D–binding protein
Meta-analyses on the association between
vitamin D and cardiovascular events and mortality
Pilz, S. et al. (2016) Vitamin D and cardiovascular disease prevention Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.73
Large, randomized, placebo-controlled trials on
vitamin D treatment effect on cardiovascular outcomes
Pilz, S. et al. (2016) Vitamin D and cardiovascular disease prevention Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.73
Population Recommendation Grade
Community-dwelling, nonpregnant,
asymptomatic adults age 18 years and older
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D
deficiency in asymptomatic adults.
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