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Lack of vitamin
D may increase heart disease risk
The same vitamin D
deficiency that can result in weak bones now
has been associated with an increased risk
of cardiovascular disease, Framingham Heart
Study researchers report in Circulation:
Journal of the American Heart Association.
“Vitamin D deficiency
is associated with increased cardiovascular
risk, above and beyond established
cardiovascular risk factors,” said Thomas J.
Wang, M.D., assistant professor of medicine
at Harvard Medical School in Boston, Mass.
“The higher risk associated with vitamin D
deficiency was particularly evident among
individuals with high blood pressure.”
In a study of 1,739
offspring from Framingham Heart Study
participants (average age 59, all
Caucasian), researchers found that those
with blood levels of vitamin D below15
nanograms per milliliter (ng/mL) had twice
the risk of a cardiovascular event such as a
heart attack, heart failure or stroke in the
next five years compared to those with
higher levels of vitamin D.
When researchers
adjusted for traditional cardiovascular risk
factors such as high cholesterol, diabetes
and high blood pressure, the risk remained
significant with a 62 percent higher risk of
a cardiovascular event in participants with
low levels of vitamin D compared to those
with higher levels.
Researchers observed
the highest rate of cardiovascular disease
events in subset analyses dividing 688
participants according to high blood
pressure status.
After researchers adjusted
for conventional cardiovascular risk
factors, participants with hypertension and
a vitamin D deficiency had about 2 times the
risk of having a cardiovascular disease
event in five years.
Researchers also found
an increase in cardiovascular risk with each
level of vitamin D deficiency.
“We found that people
with low vitamin D levels had a higher rate
of cardiovascular events over the five-year
follow-up period,” Wang said. “These results
are intriguing and suggestive but need to be
followed up with further study.”
Study participants had
no prior cardiovascular disease and were
tested for vitamin D status and then
followed for an average of 5.4 years.
The participants
attended the offspring examinations between
1996 and 2001. Researchers obtained medical
history, physical examinations and
laboratory assessments of vascular risk
factors. They also obtained medical records
related to cardiovascular disease.
Overall, 28 percent of
individuals had levels of vitamin D below15
ng/mL and 9 percent had levels below10 ng/mL.
Although levels above 30 ng/mL are
considered optimal for bone metabolism, only
10 percent of the study sample had levels in
this range, researchers said.
During follow-up:
120 participants
developed a first cardiovascular event
including fatal and nonfatal coronary heart
disease;
28 participants had
fatal or nonfatal cerebrovascular events
such as nonhemorrhagic stroke;
19 participants were
diagnosed with heart failure; and
8 had occurrences of
claudication, fatigue in the legs during
activity.
“Low levels of vitamin
D are highly prevalent in the United States,
especially in areas without much sunshine,”
Wang said. “Twenty to 30 percent of the
population in many areas has moderate to
severe vitamin D deficiency.”
Most of this is
attributed to lack of sun exposure,
pigmented skin that prevents penetration of
the sun’s rays and inadequate dietary intake
of vitamin D enriched foods, researchers
said.
“A growing body of
evidence suggests that low levels of vitamin
D may adversely affect the cardiovascular
system,” Wang said. “Vitamin D receptors
have a broad tissue distribution that
includes vascular smooth muscle and
endothelium, the inner lining of the body’s
vessels. Our data raise the possibility that
treating vitamin D deficiency, via
supplementation or lifestyle measures, could
reduce cardiovascular risk.
“What hasn’t been
proven yet is that vitamin D deficiency
actually causes increased risk of
cardiovascular disease. This would require a
large randomized trial to show whether
correcting the vitamin D deficiency would
result in a reduction in cardiovascular
risk.”
Therfore, Wang doesn’t
recommend physicians check for vitamin D
deficiency or that those with a known
vitamin D deficiency be treated to prevent
heart disease at this time.
During the past decade,
researchers have studied several other
vitamins that initially showed promise in
reducing heart disease. But the vitamins
didn’t reduce heart disease in subsequent
large randomized trials.
“On the flip side, just
because other vitamins haven’t succeeded
doesn’t preclude the possibility of finding
vitamins that might prevent cardiovascular
disease,” Wang said. “This is always an area
of great interest. Vitamins are easy to
administer and in general have few toxic
effects.”
The American Heart
Association recommends that healthy people
get adequate nutrients by eating a variety
of foods in moderation, rather than by
taking supplements. Food sources of vitamin
D include milk, salmon, mackerel, sardines,
cod liver oil and some fortified cereals.
Vitamin or mineral supplements aren’t a
substitute for a balanced, nutritious diet
that limits excess calories, saturated fat,
trans fat, sodium and dietary cholesterol.
This dietary approach has been shown to
reduce coronary heart disease risk in
healthy people and those with coronary
disease.
###
Co-authors are: Michael
J. Pencina, Ph.D.; Sarah L. Booth, Ph.D.;
Paul F. Jacques, D.Sc.; Erik Ingelsson,
M.D., Ph.D.; Katherine Lanier, B.S.; Emelia
J. Benjamin, M.D.; Ralph B. D’Agostino,
Ph.D.; Myles Wolf, M.D.; and Ramachandran S.
Vasan, M.D. The National Institute of
Health, U.S. Department of Agriculture and
American Heart Association funded the study.
Statements and
conclusions of study authors that are
published in the American Heart Association
scientific journals are solely those of the
study authors and do not necessarily reflect
association policy or position.
The American
Heart Association makes no representation or
warranty as to their accuracy or
reliability.
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