Vitamin D & Heart Disease
Is Vitamin D an Important
Cardiovascular Risk Marker?
James M Falko, MD
Professor of Medicine
University of Colorado at Denver
Vitamin D & Heart Disease
• Vit D receptors are present in
cardiomyocytes, beta cells, vascular
endothelial cells and osteoblasts.
• Vit D deficiency plays an important
role in CV risk.
• Vit D deficiency is ass’d with DM,
HTN, Met Syn, LVH, CHF and Vascular
Inflammation.
Vitamin D Basics
• Vit D2 (ergocalciferol) – Plant Sources
• Vit D3 (cholecalciferol) – A product of UVB
irradiaton of 7-dehydrocholesterol
synthesis in the skin, or from oily fish,
fortified foods or supplementation
• Vit D → 25- OH D → 1, 25 OH D
• Serum levels of 1, 25 OH D are not helpful
in assessing Vitamin D stores
Vitamin D Status 25-(OH) D
Level (ng/dL)
Status
< 10
Severe deficiency
10 -20
Deficiency
21 – 29
Insufficiency
> 30
Sufficient
> 150
Toxicity
Risk Factors for Vit D Deficiency
• Elderly, Homebound
• Deeply pigmented skin
• Distance from Equator
• Winter
• Air pollution, smoking, obesity
• Malabsorption, liver & renal disease
• Medications
Probability of CV Disease in
Hypertensive Subjects
25-(OH) D
<15 ng/mL
Significant
25-(OH) D
> 15 ng/mL
Wang et al, Circulation 2008;117:503-11
Cardiac & Stroke Mortality and
25-(OH) D Levels
2
25
50
25-(OH) D ng/mL
Wang et al, Ann Intern Med 2010;152:315-23
75
100
Severe Deficiency 25-(OH) D & CVD
< 10
10 - 15
25-(OH) D ng/mL
Wang et al, Ann Intern Med 2010;152:315-23
> 15
PTH vs. Vitamin D
100
90
80
PTH (pg/mL)_
70
60
50
40
30
20
0-5
10 +
15+
16+
21+
25-(OH) D ng/mL
26+
>30
Potential Mechanisms for CV Toxicity &
Vit D Deficiency
Vitamin D Deficiency
Insulin Resistance
+
Beta Cell Dysfunction
Diabetes &
Metabolic Syndrome
↑ PTH
↑ RAAS
↑ Inflammation
HTN /
Hypertrophy
↑ Atherosclerosis
↑ CVD
Selected Food Sources of Vit D
Food
Cod Liver Oil, (1 tablespoon)
Wild Salmon, (3 oz)
Farmed Salmon, (3 oz)
Mackerel, (3 oz)
Tuna fish in oil, (3 oz)
Sardines in oil, (1 oz)
Milk, (1 cup)
IU/serving
1,360
600-1,000
100-250
345
200
250
98
NIH
Treatment Recommendations for
Vitamin D Deficiency
Vitamin D Deficiency
25(OH)D < 20 ng/dL
50,000 IU of D2 or D3
Per Week X 8 weeks
Maintenance Therapy
(Choices)
50,000 IU of D2
Every 2 Weeks
1- 2,000 IU of D3
Daily
Recheck 25(OH)D in 3 to 6 months
Vitamin D & Statin Myopathy
Myalgia n = 128
Distribution Density
ASx n = 493
38 of 128 with 25-(OH) D < 32 ng/dL:
Given Vit 50,000 IU per week x 3 mos
10
20
30
40
50
60
25-(OH) D ng/mL
Ahmed et al, Translational Research 2009; 153:11-16
70
80
90
Results of Vit D Therapy in Statin
Myopathy
At FU
n
Asymptomatic
35
20 +/- 7
48 +/- 17
<.0001
3
20 +/- 8
49 +/- 30
---
38
20 +/-7
48 +/-18
<.0001
Myalgia
All
Initial Vit D (ng/mL) FU Vit D Level (ng/mL)
38 of 128 with 25-(OH) D < 32 ng/dL:
Given Vit 50,000 IU per week x 3 mos
P value
Trials of Vit D Supplementation
• 4 Trials – Not Significant on CV
Outcomes
• Several Trials show possible
improvement in blood pressure
Wang et al, Ann Intern Med 2010;152:315-23
Conclusions:
• Vit D levels correlate with CV Disease
• Supplementation possibly may improve CV
Outcomes but trials are needed
• Vit D levels should be obtained in CV
patients and supplementation considered,
especially if treated with Statins
Wang et al, Ann Intern Med 2010;152:315-23
Selected References
• Vitamin D Deficiency. JACC 2008:52;19491956
• Low Vitamin D is associated with
reversible Statin Myopathy. Translational
Research 2009:153;11-16
• Systematic Review: Vitamin D and Calcium
Supplementation in Prevention of CV
Events Ann Inern Med 2010: 152; 315-323