Vitamin D Deficiency and Risk for Cardiovascular Disease

doi:10.1097/MAJ.0b013e3181aaee91

The American Journal of the Medical Sciences

Volume 338, Issue 1, July 2009, Pages 40-44

https://doi.org/10.1097/MAJ.0b013e3181aaee91 Get rights and content

Abstract

Vitamin D is an important prohormone for optimal intestinal calcium absorption for mineralization of bone. Because the vitamin D receptor is present in multiple tissues, there has been interest in evaluating other potential functions of vitamin D, particularly, in cardiovascular diseases (CVD). Cross-sectional studies have reported that vitamin D deficiency is associated with increased risk of CVD, including hypertension, heart failure, and ischemic heart disease. Initial prospective studies have also demonstrated that vitamin D deficiency increases the risk of developing incident hypertension or sudden cardiac death in individuals with preexisting CVD. Very few prospective clinical studies have been conducted to examine the effect of vitamin D supplementation on cardiovascular outcomes. The mechanism for how vitamin D may improve CVD outcomes remains obscure; however, potential hypotheses include the downregulation of the reninangiotensin-aldosterone system, direct effects on the heart, and vasculature or improvement of glycemic control. This review will examine the epidemiologic and clinical evidence for vitamin D deficiency as a cardiovascular risk factor and explore potential mechanisms for the cardioprotective effect of vitamin D.

Section snippets

Physiology of Vitamin D

Vitamin D can be produced in the skin as vitamin D₃ on exposure to ultraviolet-B (UVB) from the sun or obtained from the diet as vitamin D₂ or vitamin D₃. After vitamin D enters the body, it circulates bound to vitamin D-binding protein and is rapidly converted to its major circulating form, 25-hydroxy-vitamin D (25(OH)D), by the liver. Under the influence of PTH, 25(OH)D is converted by the 1-alpha-hydroxylase (1α-OHase) in the kidney to form the hormonal form of vitamin D,

CONCLUSION

Vitamin D insufficiency is very common in the United States and worldwide. Several recent epidemiologic studies have demonstrated a strong association between vitamin D insufficiency and risk of CVD, risk of diabetes and metabolic syndrome. Several prospective studies have suggested that vitamin D deficiency predisposes individuals to increased risk of incident hypertension, IHD, sudden cardiac death, or heart failure. Initial randomized clinical trials of vitamin D in the treatment of

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