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Another Link Between Vitamin D Levels and Cardiovascular Health
By Floyd Arthur
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Researchers at the Intermountain Medical Center Heart Institute in Salt Lake City,
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Utah, have found a link between total and bioavailable vitamin D levels and
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cardiovascular health. A team led by Dr. Heidi May, a cardiovascular epidemiologist at
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the Institute, found that patients in whom both total vitamin D and bioavailable
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vitamin D were low had the poorest cardiovascular outcomes.
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Dr. May’s team measured the levels of various vitamin D metabolites in 4,200 patients
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aged 52 to 76. Seventy percent of the study population had preexisting cardiovascular
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disease, and about 25 percent had diabetes.
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The research was presented at the American College of Cardiology Scientific Sessions in
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Chicago, Illinois, held April 1 through April 4, 2016.
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Vitamin D Levels and Cardiovascular Disease
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A growing body of research links low vitamin D levels to a higher incidence of heart
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attacks, peripheral arterial disease, congestive heart failure and stroke. Additionally,
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low vitamin D levels are commonly linked to conditions associated with CVD, such as
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obesity, hypertension and diabetes.
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Only about 10 to 15 percent of total vitamin D in the body is available to pursue target
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cells, Dr. May explains. The remaining metabolites are bound to proteins. Measuring
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both total levels and bioavailable vitamin D appears to be important to determining
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overall cardiovascular risk.
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Predisposing Factors in Low Vitamin D Levels
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“Vitamin D” is it is not a vitamin in the strict sense of the word. It is a fat-soluble
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secosteroid produced in the skin from the action of ultraviolet light on 7-
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dehydrocholesterol. Thus, low vitamin D levels are most often linked to decreased
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exposure to UV light.
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Over the past several decades the American population has spent more time indoors and
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increased its use of sunscreen when outdoors in the sun. As a result, the incidence of low
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vitamin D levels has increased.
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Vitamin D can be obtained from dietary sources such as fish oils, egg yolk, butter, liver
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and fortified foods. However, endogenous production is much more important to
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maintaining vitamin D levels in most individuals.
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Other important factors in vitamin D absorption include body weight, skin
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pigmentation, sex and age.
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* Fat cells absorb vitamin D, so obese individuals are more prone to vitamin D deficiency. This
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correlation may explain the link between vitamin D deficiency and conditions associated
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with obesity, such as Type 2 diabetes, CVD and hypertension.
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* Fair skinned people absorb more vitamin D than those with darker skin due to lower levels
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of melanin in the skin.
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* Women have lower vitamin D levels than men. This may be due to the fact that women
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generally have more body fat than men and traditionally spend more time indoors. Women
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also tend to wear sun protection more often than men.
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* The ability to absorb vitamin D decreases as people age, so people over 55 tend to have lower
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levels of vitamin D. This effect may be intensified by the fact that older or medically frail
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individuals tend to spend less time outdoors.
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Additionally, those who live at higher latitudes tend to have lower levels of vitamin D
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due to the decreased intensity of ultraviolet light.
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What Are “Normal” Vitamin D Levels
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Over the past several decades, optimal levels of vitamin D have been defined and
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redefined. Historically, appropriate levels were determined by those found in healthy
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populations, and so the lower end of the range was frequently set between 25 and 35
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nmol/l. However, in the face of evidence linking levels below 50 nmol/l to greater all-
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cause mortality, those numbers have been refined.
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Today in the United States, the lower level of the reference range typically sits between
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40 nmol/ and 120 nmol/l, with the majority of researchers suggesting that levels of 75
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nmol/l are optimal. However, there are virtually no clinical trials supporting
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supplementation for levels in this range.
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Treating Low Vitamin D Levels
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The logical clinical approach to treating suspected vitamin D deficiency is to measure
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vitamin D levels and supplement those whose levels fall in the suboptimal range.
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However, measuring vitamin D levels is expensive and inexact: Values from different
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laboratories can vary by as much as 40 percent.
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Thus, many clinicians choose to prescribe universal supplementation for persons in
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“high-risk” groups, such as those who are elderly, medically frail, homebound or dark
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skinned and living at higher latitudes. According to one study published in the Journal
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of the American Geriatric Society, the cost-effectiveness of either approach in patients
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65 to 80 is about the same.
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If the clinician and patient choose supplementation, a dose of 500 to 1000 units per day
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or 50,000 units per month are typically sufficient to achieve vitamin D levels of greater
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than than 50 nmol/l. Some advocates of higher vitamin D levels suggest daily doses of
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2,000 units, which will typically achieve levels of 100 nmol/l or higher. However, there
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is some evidence that vitamin D levels above 120 lead to a greater incidence of falls and
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fractures, so it is most likely safest to maintain levels at 100 nmol/l or below.
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Conclusion
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The relationship between low vitamin D levels and all-cause mortality is well-
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established, and a growing body of research suggests a link between vitamin D
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deficiency and cardiovascular risk. However, these correlations are confounded by
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comorbidities that often exist in persons with low vitamin D, such as obesity, low
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activity levels, dyslipidemia, hypertension and diabetes. More research is needed to
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establish whether a causative relationship between low vitamin D levels and
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cardiovascular disease actually exists.