Elsevier

Maturitas

Volume 65, Issue 3, March 2010, Pages 225-236
Maturitas

Review
Levels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis

https://doi.org/10.1016/j.maturitas.2009.12.013Get rights and content

Abstract

Cardiometabolic disorders and vitamin D deficiency are becoming increasingly more prevalent across multiple populations. Different studies have suggested a potential association between abnormal vitamin D levels and multiple pathological conditions including cardiovascular diseases and diabetes.

We aimed to evaluate the association between vitamin D levels, using 25-hydroxy vitamin D (25OHD) as an indicator of vitamin D status, and the presence of cardiometabolic disorders including cardiovascular disease, diabetes and metabolic syndrome.

We performed a systematic review of the current literature on vitamin D and cardiometabolic disorders using the PubMed and Web of Knowledge databases in September 2009. Studies in adults looking at the effect of vitamin D levels on outcomes relating to cardiometabolic disorders were selected. We performed a meta-analysis to assess the risk of developing cardiometabolic disorders comparing the highest and lowest groups of serum 25OHD.

From 6130 references we identified 28 studies that met our inclusion criteria, including 99,745 participants. There was moderate variation between the studies in their grouping of 25OHD levels, design and analytical approach. We found that the highest levels of serum 25OHD were associated with a 43% reduction in cardiometabolic disorders [OR 0.57, 95% (CI 0.48–0.68)]. Similar levels were observed, irrespective of the individual cardiometabolic outcome evaluated or study design. High levels of vitamin D among middle-age and elderly populations are associated with a substantial decrease in cardiovascular disease, type 2 diabetes and metabolic syndrome. If the relationship proves to be causal, interventions targeting vitamin D deficiency in adult populations could potentially slow the current epidemics of cardiometabolic disorders.

Introduction

Cardiometabolic disorders including cardiovascular disease (CVD), type 2 diabetes mellitus (DM) and metabolic syndrome (MetS) are major causes of morbidity and mortality worldwide [1], [2]. Hypertension, dyslipidema, central obesity and glycaemic dysregulations are known risk factors for CVD [2]. Metabolic syndrome represents the clustering of these risk factors that together lead to increased risk of developing CVD and DM [3].

Vitamin D deficiency is also highly prevalent in different populations across the world. Studies suggest that approximately 30–50% of the adult population are at risk of vitamin D deficiency [4], [5]. The older adult population is especially vulnerable to vitamin D deficiency, due to a decreased capacity to synthesise vitamin D from sunlight [6]. Additionally, aging is associated with lower 7-dehydrocholesterol levels [7], which is a precursor required for synthesis of vitamin D in the skin.

Vitamin D is known to play an important role in bone and mineral homeostasis and has also been linked with multiple other pathophysiological mechanisms. The vitamin D binding receptor is not only expressed in tissues involved in calcium homeostasis but also found in more than 36 other tissue types [8] and vitamin D has more recently been implicated in a number of additional pathological processes. These processes include cancer, multiple sclerosis, psoriasis and the inflammatory response [9], [10], [11], supporting a role for vitamin D in delineating healthy trajectories of aging.

There is also growing evidence to support the link between abnormal levels of vitamin D and CVD and DM [4], [12], [13], [14]. However, the published literature differs substantially in terms of methodology, populations and results presented. Therefore the evidence remains inconclusive or incongruent.

We aimed, by critically appraising the current evidence, to evaluate the overall effects of vitamin D levels on potential risk of developing cardiometabolic disorders (CVD, DM and MetS). We also aimed to evaluate whether the association between vitamin D and cardiovascular disease, diabetes and metabolic syndrome would differ by type of cardiometabolic disorder, study design, gender, age and ethnicity.

Section snippets

Methods

We performed a systematic review and meta-analysis of studies that evaluate the relationship between vitamin D levels and cardiometabolic disorders in adults. We used the measurement of serum 25-hydroxy vitamin D (25OHD) as a proxy for vitamin D status [15].

Study selection

We retrieved 3952 references from the PubMed database and 4088 from Web of Knowledge databases. 1910 duplications were identified and removed, leaving a total of 6130 references (Fig. 1). Initial screening of the title and abstract resulted in the exclusion of 6049 references leaving 81 articles to source in full text. No additional references were identified from searching reference lists of the 81 full text papers. We received eight articles from authors directly, three of which were already

Discussion

Overall we found that high levels of vitamin D are associated with a 43% reduction in cardiometabolic disorders, this finding applied to all outcomes reported (CVD, DM or MetS), although at different levels of magnitude, and was independent of the study design.

The majority (85%) of the studies’ results were in agreement with this main finding.

When we evaluated the effects of vitamin D levels on the risk of the individual outcomes included we found a significant association between high levels

Ethical approval

Ethical approval was not required as this was a secondary data analysis.

Contributors

All authors participated actively in the preparation of the manuscript at all stages: search strategy, study selection, data analyses, and drafting of the manuscript.

Competing interest

None of the authors had any financial or personal conflict of interest to disclose.

Provenance

Commissioned and externally peer reviewed.

Acknowledgments

We would like to thank Samantha Johnson from Warwick University library services, for her advice and support with the search strategy.

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    Oscar H. Franco as guarantor of this paper accepts full responsibility for the integrity of the data and the accuracy of the data analysis, had full access to all the data in the study, and controlled the decision to publish.

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