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The role of vitamin D deficiency in cardiovascular disease: where do we stand in 2013?

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Abstract

The high worldwide prevalence of vitamin D deficiency is largely the result of low sunlight exposure with subsequently limited cutaneous vitamin D production. Classic manifestations of vitamin D deficiency are linked to disturbances in bone and mineral metabolism, but the identification of the vitamin D receptor in almost every human cell suggests a broader role of vitamin D for overall and cardiovascular health. The various cardiovascular protective actions of vitamin D such as anti-diabetic and anti-hypertensive effects including renin suppression as well as protection against atherosclerosis and heart diseases are well defined in previous experimental studies. In line with this, large epidemiological studies have highlighted vitamin D deficiency as a marker of cardiovascular risk. However, randomized controlled trials (RCTs) on vitamin D have largely failed to show its beneficial effects on cardiovascular diseases and its conventional risk factors. While most prior vitamin D RCTs were not designed to assess cardiovascular outcomes, some large RCTs have been initiated to evaluate the efficacy of vitamin D supplementation on cardiovascular events in the general population. When considering the history of previous disappointing vitamin RCTs in general populations, more emphasis should be placed on RCTs among severely vitamin D-deficient populations who would most likely benefit from vitamin D treatment. At present, vitamin D deficiency can only be considered a cardiovascular risk marker, as vitamin D supplementation with doses recommended for osteoporosis treatment is neither proven to be beneficial nor harmful in cardiovascular diseases.

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Acknowledgments

Martin Gaksch is supported by funding of the Austrian National Bank (Jubilaeumsfond: Project Numbers: 13878 and 13905).

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria

    Stefan Pilz & Martin Gaksch

  2. Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT, Amsterdam, The Netherlands

    Stefan Pilz

  3. Department of Internal Medicine/Geriatrics, Adler Geriatric Center, Yale School of Medicine, New Haven, CT, 06510, USA

    Bríain O’Hartaigh

  4. Department of Cardiology, Medical University of Graz, 8036, Graz, Austria

    Andreas Tomaschitz

  5. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036, Graz, Austria

    Winfried März

  6. Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Mannheim Medical Faculty, University of Heidelberg, 68167, Mannheim, Germany

    Winfried März

  7. Synlab Laboratory Services GmbH, Synlab Academy, 68165, Mannheim, Germany

    Winfried März

  8. Specialist Clinic for Rehabilitation PV Bad Aussee, 8990, Bad Aussee, Austria

    Andreas Tomaschitz

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  1. Stefan Pilz
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  2. Martin Gaksch
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  3. Bríain O’Hartaigh
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  4. Andreas Tomaschitz
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  5. Winfried März
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Correspondence to Stefan Pilz.

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Pilz, S., Gaksch, M., O’Hartaigh, B. et al. The role of vitamin D deficiency in cardiovascular disease: where do we stand in 2013?. Arch Toxicol 87, 2083–2103 (2013). https://doi.org/10.1007/s00204-013-1152-z

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