Review
Role of Vitamin D in Cardiovascular Health

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Observational studies strongly associate vitamin D deficiency with a variety of cardiovascular diseases beyond defects in bone and calcium metabolism. Vitamin D has multiple mechanisms that potentially may affect cardiovascular health. Because vitamin D deficiency is common, therapies directed at the replacement of vitamin D may be beneficial. To date however, studies evaluating vitamin D supplementation are few and have not consistently shown benefit. It is possible that the lack of benefit in these studies may have arisen from suboptimal levels of vitamin D supplementation or other unknown factors. Nevertheless, the growing body of observational data and consistent findings of relatively high rates of low vitamin D serum levels warrant further well-designed studies to investigate the relation between vitamin D and cardiovascular health. In conclusion, vitamin D is now recognized as important for cardiovascular health and its deficiency as a potential risk factor for several cardiovascular disease processes.

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Metabolism of Vitamin D

Vitamin D belongs to a group of secosteroid molecules that are traditionally associated with bone and calcium metabolism. Although 5 forms of vitamin D (D1 through D5) are known, vitamins D2 and D3 are the most studied forms (Table 1). Ergocalciferol, or vitamin D2, is principally synthesized in plants and invertebrates. It is typically consumed in the human diet and as supplements or fortified products. Cholecalciferol, or vitamin D3, is mainly of vertebrate animal origin and commonly consumed

Sources of Vitamin D and Normal Serum Levels

Cutaneous synthesis of vitamin D3 from sunlight exposure is the major source (80% to 90%) of vitamin D in humans under natural conditions.3 Total-body sun exposure to 1 minimal erythemal dose while wearing a bathing suit provides the equivalent of 250 to 500 μg (10,000 to 20,000 IU) of vitamin D per day.4 The dietary supply of vitamin D is minor compared to cutaneous formation but can become an important source of vitamin D with supplementation. Oily fish such as salmon, mackerel, herring, and

Epidemiology of Vitamin D Deficiency

Vitamin D, under ideal conditions, is probably not required in the diet, because most mammals including humans can synthesize it from direct sunlight exposure. However, worldwide, most humans typically expose ≤5% of their skin to infrequent periods of unshielded sunlight, a behavior that commonly leads to vitamin D deficiency. This is far less solar exposure than that experienced in most historical human cultures and among free-living primates. In 1 study, 36% of young healthy free-living

Recommended Daily Intake, Toxicity, and Assay of Vitamin D

The present recommended daily dose of vitamin D is 400 IU. It has been estimated that for every 100 IU of vitamin D ingested, the blood level of 25(OH) vitamin D increases by 1 ng/ml (2.5 nmol/L).12, 13 For many individuals, the present recommended daily allowance may not be sufficient to achieve optimal serum concentrations of vitamin D.14 African Americans with low sun exposure require 2,100 to 3,100 IU/day of oral vitamin D throughout the year to achieve a serum 25(OH) vitamin D

Clinical Conditions Associated With Vitamin D Deficiency

A wide range of cardiovascular disease states have been associated with vitamin D deficiency involving multiple potential mechanisms (Table 2).

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