Article

Systematic Review: Vitamin D and Calcium Supplementation in Prevention of Cardiovascular Events

Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts 02215, USA.
Annals of internal medicine (Impact Factor: 16.1). 03/2010; 152(5):315-23. DOI: 10.1059/0003-4819-152-5-201003020-00010
Source: PubMed

ABSTRACT Vitamin D and calcium may affect the cardiovascular system independently and interactively.
To assess whether vitamin D and calcium supplements reduce the risk for cardiovascular events in adults.
Studies published in English from 1966 to July 2009 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.
Two investigators independently selected 17 prospective studies and randomized trials that examined vitamin D supplementation, calcium supplementation, or both and subsequent cardiovascular events.
Three investigators extracted and checked data about study designs, participants, exposures or interventions, outcomes, and data quality.
Five prospective studies of patients receiving dialysis and 1 study involving a general population showed consistent reductions in cardiovascular disease (CVD) mortality among adults who received vitamin D supplements. Four prospective studies of initially healthy persons found no differences in incidence of CVD between calcium supplement recipients and nonrecipients. Results of secondary analyses in 8 randomized trials showed a slight but statistically nonsignificant reduction in CVD risk (pooled relative risk, 0.90 [95% CI, 0.77 to 1.05]) with vitamin D supplementation at moderate to high doses (approximately 1000 IU/d) but not with calcium supplementation (pooled relative risk, 1.14 [CI, 0.92 to 1.41]), or a combination of vitamin D and calcium supplementation (pooled relative risk, 1.04 [CI, 0.92 to 1.18]) compared with placebo.
Only articles published in English that reported cardiovascular event outcomes were included. The small number of studies, the lack of trials designed specifically to assess primary effects on cardiovascular outcomes, and important between-study heterogeneity preclude definitive conclusions.
Evidence from limited data suggests that vitamin D supplements at moderate to high doses may reduce CVD risk, whereas calcium supplements seem to have minimal cardiovascular effects. Further research is needed to elucidate the role of these supplements in CVD prevention.
The American Heart Association and the National Heart, Lung, and Blood Institute.

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    • "Numerous studies have shown that low 25(OH)D levels are associated with an increase in CVD [49] [50] [64] and associated CVD risk factors such as hypertension [65] and insulin resistance [66]. A meta-analysis of prospective studies also suggested that moderate doses of vitamin D may be beneficial in reducing CVD [67], although the interventional trials needed to answer this question are lacking. "
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    ABSTRACT: Deficiency of 1,25(OH)2 vitamin D is inevitable in CKD, and is part of a cascade of bone and mineral abnormalities that result in secondary hyperparathyroidism. The widespread acceptance of calcitriol therapy as the treatment paradigm, has resulted in an overall neglect of vitamin D deficiency, as defined by low serum 25(OH)D levels Recent research has greatly enhanced our understanding of the disordered vitamin D metabolism seen in CKD. Furthermore vitamin D has been implicated in numerous disease states, beyond its traditional role in regulating bone and mineral metabolism. Low serum 25(OH)D levels have been linked to numerous adverse clinical outcomes in health and CKD. Additionally, the recognition of extra-renal, autocrine 1,25(OH)2D synthesis, present in many tissues, has refocused attention on the therapeutic potential of correcting low serum 25(OH)D levels. In this review we examine the physiology of disordered vitamin D metabolism in CKD, the clinical associations of low 25(OH)D levels in CKD, and discuss the rationale for vitamin D replacement in current clinical practice.
    Clinical nephrology 07/2015; 84 (2015)(08). DOI:10.5414/CN108519 · 1.23 Impact Factor
    • "Numerous studies have shown that low 25(OH)D levels are associated with an increase in CVD [49] [50] [64] and associated CVD risk factors such as hypertension [65] and insulin resistance [66]. A meta-analysis of prospective studies also suggested that moderate doses of vitamin D may be beneficial in reducing CVD [67], although the interventional trials needed to answer this question are lacking. "
    Clinical Journal of the American Society of Nephrology 03/2015; 10(4). DOI:10.2215/CJN.01780215 · 5.25 Impact Factor
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    • "Moreover, similar findings have been reported that decreased 25(OH)D levels increased the incidence of subsequent cardiovascular and cerebrovascular events.2,20 Interestingly, the effects of vitamin D supplements on reducing cardiovascular events are another reason for considering vitamin D as a probable pathophysiological agent for developing cardiovascular diseases.21 "
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    ABSTRACT: Background Vitamin D has been shown to have an anticoagulant effect. A decrease in 25-hydroxyvitamin D [25(OH)D] concentration has also been associated with an increased risk of venous thromboembolism. Hence, we sought to determine the relationship between 25(OH) D levels and idiopathic lower-extremity deep vein thrombosis (DVT). Methods In a case control study, a total of 82 participants with idiopathic lower-extremity DVT were enrolled along with 85 sex- and age-matched healthy participants as controls. The plasma 25(OH)D levels were measured in all the studied samples. Results The participants’ mean age was 47.1±12.3 years. Baseline characteristics were not significantly different between the groups. The concentration of 25(OH)D was significantly lower in the DVT group compared to that of the control group (17.9±10.3 versus 23.1±12.5 ng/mL, P=0.004). The prevalence of participants with deficient 25(OH)D levels was significantly higher in the both DVT and control groups than those with sufficient 25(OH)D levels (68.3% versus 13.4%, and 49.4% versus 28.2%, respectively, P=0.027). In a multivariate analysis, 25(OH)D levels and sex were found to be the only independent predictors of DVT (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.08, P=0.001 and OR 0.51, 95% CI 0.26–1.00, P=0.049, respectively). Conclusion Low levels of 25(OH)D are associated with idiopathic lower-extremity DVT. Further investigation is needed to establish determinants and probable causative role of 25(OH)D.
    International Journal of General Medicine 06/2014; 7:303-9. DOI:10.2147/IJGM.S64812
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