Vitamin D and cardiovascular disease prevention

• Published in: Nature reviews cardiology Vol. 13; no. 7; pp. 404 - 417
• Main Authors: Pilz, Stefan, Verheyen, Nicolas, Grübler, Martin R., Tomaschitz, Andreas, März, Winfried
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2016; Nature Publishing Group
• Subjects: 692/4019/592/75; 692/700/2814; 692/700/459; 692/700/459/1994; Alfacalcidol; Analysis; Calcifediol; Cardiac Imaging; Cardiac Surgery; Cardiology; Cardiovascular diseases; Health aspects; Innovations; Medicine & Public Health; Medicine, Preventive; Physiological aspects; Prevention; Preventive health services; review-article; Vitamin D
• ISSN: 1759-5002; 1759-5010; 1759-5010
• DOI: 10.1038/nrcardio.2016.73

Key Points The vitamin D receptor (VDR) and enzymes for vitamin D metabolism are expressed throughout the cardiovascular system VDR and 1α-hydroxylase knockout mice have hypertension with myocardial hypertrophy and increased activity of the renin–angiotensin–aldosterone system The molecular effects of VDR activation indicate various antiatherosclerotic and protective effects on the heart and on common cardiovascular risk factors Observational studies have shown that low 25-hydroxyvitamin D levels are associated with an adverse cardiovascular risk profile and significantly increased risk of cardiovascular events Mendelian randomization studies and randomized clinical trials have not shown significant effects of vitamin D on cardiovascular events, but these trials were not designed to investigate cardiovascular outcomes in vitamin D-deficient individuals Vitamin D supplementation is currently not indicated for the purpose of cardiovascular disease prevention, but treatment of vitamin D deficiency is critical for skeletal health This Review summarizes the existing knowledge on the effects of vitamin D on cardiovascular diseases and the associated risk factors. Pilz and colleagues provide an update on clinical studies on vitamin D and cardiovascular risk, discuss ongoing vitamin D research, and consider the management of vitamin D deficiency from the perspective of cardiovascular health. Vitamin D is a precursor of the steroid hormone calcitriol that is crucial for bone and mineral metabolism. Both the high prevalence of vitamin D deficiency in the general population and the identification of the vitamin D receptor in the heart and blood vessels raised interest in the potential cardiovascular effects of vitamin D. Experimental studies have demonstrated various cardiovascular protective actions of vitamin D, but vitamin D intoxication in animals is known to induce vascular calcification. In meta-analyses of epidemiological studies, vitamin D deficiency is associated with an increased cardiovascular risk. Findings from Mendelian randomization studies and randomized, controlled trials (RCTs) do not indicate significant effects of a general vitamin D supplementation on cardiovascular outcomes. Previous RCTs, however, were not adequately designed to address extraskeletal events, and did not focus on vitamin D-deficient individuals. Therefore, currently available evidence does not support cardiovascular benefits or harms of vitamin D supplementation with the commonly used doses, and whether vitamin D has cardiovascular effects in individuals with overt vitamin D deficiency remains to be evaluated. Here, we provide an update on clinical studies on vitamin D and cardiovascular risk, discuss ongoing vitamin D research, and consider the management of vitamin D deficiency from a cardiovascular health perspective.