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DNC News: Vitamin D and cardiovascular disease

 

Subject: Low levels of Vitamin D may trigger cardiovascular disease, heart attack and high blood pressure. Supplementation may be therapeutic in treating these conditions.

 

When I remember just two things from the Nutrition 101 class I took in 1981: not enough Vitamin D and a kid gets Rickets and too much is toxic. IN the last few years the view of the role Vitamin D plays in health has changed dramatically. Vitamin D may play an essential role in preventing cardiovascular disease, diabetes, auto immune disease like multiple sclerosis, depression and cancer. The doses of Vitamin D, which we now use and feel to be both safe and therapeutic, are 5-10 times higher than what was once considered to be the upper limit for supplementation.

 

This is a big topic and I'm going to break it into several sections. Tonight I want to focus on Vitamin D's role in preventing and treating cardiovascular disease.

 

More people die from cardiovascular disease in the winter than in the summer. I was once taught that this was because cold weather stressed the heart and precipitated cardiac events. One might also argue that people don't get as much fresh fruits and vegetables in the winter and so they are less protected. [i] More people die from cardio

Deaths from cardiovascular disease are more common in the winter; they are also more common at higher latitudes and more common at low altitudes. Low altitudes are easier on the heart than high altitudes. What do all these factors have in common? These are all things which will lower Vitamin D. [ii]

 

Vitamin D status is measured by a blood test for25 (OH)D. People with low levels of Vitamin D, a 25(OH)D level of less than 34 ng/ml, have twice the number of heart attacks of people who have a 25(OH)D greater than 34. [iii] Low Vitamin D doubles your risk of a heart attack or the other way around, good Vitamin D levels cut your heart attack risk by half.

 

Everyone assumes that outdoorsy people are healthy because of all the exercise and fresh air they get. Well here is another possible explanation. Men who engage in some sort of outdoor leisure hobby have almost 5 times the Vitamin D levels of inactive men. Remember Vitamin D is made in the skin when exposed to sunlight. [iv] The more sun, the more Vitamin D.

 

The darker a person's skin is the harder it is for them to make Vitamin D while in the sun. As a result dark skin people have lower levels of Vitamin D than fair skinned people. This may explain why darker skinned people in northern latitudes are at a greater risk for cardiovascular disease and high blood pressure. [v]

 

People who develop congestive heart failure have much lower Vitamin D levels when compared to people who don't develop this disease. [vi] These patients also have a much higher rate of bone loss and osteoporosis, both conditions are associated with low D. [vii] There are numerous case reports of patients with low vitamin D levels who develop congestive heart failure. [viii] [ix] [x]

Vitamin D may also affect blood pressure.

Blood pressures on average increase during the winter and go back down in the summer. The further people live from the equator or the darker a person's skin is the higher their blood pressure. All of these factors are things which influence Vitamin D levels. [xi]

Experiments in which people are exposed to ultraviolet light have been successful at increasing their Vitamin D levels and decreasing their blood pressure. [xii]

Treating elderly women even in the short term lowered their blood pressure and their heart rates. [xiii]

 

All these things being the case Vitamin D is a reasonable supplement to consider using in patients with cardiovascular problems including both congestive heart failure and high blood pressure.

 

 

 

References: 

 

[i] Public Health Nutr. 2000 Mar;3(1):19-29.

Seasonal consumption of salad vegetables and fresh fruit in relation to the development of cardiovascular disease and cancer.

 

Cox BD, Whichelow MJ, Prevost AT.

 

Department of Community Medicine, Institute of Public Health , Cambridge , UK . bdc10@cus.cam.ac.uk

 

OBJECTIVE: To investigate the protective association between seasonality of consumption of fresh fruit or salad vegetables and cancer and cardiovascular disease (CVD) development. DESIGN AND SETTING: Face-to-face interviews, including a food frequency questionnaire, were conducted on 1489 men and 1900 women, aged 35-75 years, who were respondents in the British Health and Lifestyle Survey 1984/85 (HALS1). CVD and cancer morbidity and mortality were determined from the 1991/92 British Health and Lifestyle Survey (HALS2) and by NHS Register 'flagging'. RESULTS: Risk was assessed by odds ratio (OR) for trend per frequency category. In men, frequent winter salad vegetable consumption was more closely protective than that in summer for cancer (winter OR=0.79 [0.62-0.99], P=0.045, summer OR=0.83 [0.69-1.01], NS) and CVD (winter OR=0.85 [0.72-1.00], P=0.049, summer OR=0.95 [0.82-1.10], NS). Fresh fruit consumption showed no significant protection. In women, frequent salad vegetable consumption at any season was significantly protective of CVD (winter OR=0.76 [0.65-0.89], P<0.001, summer OR=0.76 [0.65-0.89], P<0.001), although not of cancer. Frequent fresh fruit consumption in women was significantly protective of CVD (winter OR=0.84 [0.74-0.94], P=0.004, summer OR=0.85 [0.74-0.97], P=0.014) but not quite significant, and only in winter, for cancer (winter OR=0.87 [0.76-1.00], P=0.052, summer OR=0.88 [0.75-1.02], P=0.097). Maintenance of salad vegetable consumption from summer to winter, to within one frequency category, was associated with further protection for cancer in men (P=0.050) and CVD in women (P=0.024). CONCLUSIONS: Diets high in fresh fruit and salad vegetables appear protective against cancer and CVD. It is important to take into account the seasonality of consumption in estimating and establishing significance of risk.

 

PMID: 10786720 [PubMed - indexed for MEDLINE]

 

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[ii] Int J Epidemiol. 1981 Dec;10(4):337-41.

Seasonality of cardiovascular disease mortality and the possible protective effect of ultra-violet radiation.

 

Scragg R.

 

Previous studies suggested that cardiovascular disease (CVD) seasonality is due to variations in temperature or respiratory disease prevalence. Another mechanism might be that the seasonal variation in ultra-violet (UV) radiation is responsible for the seasonality of CVD. An hypothesis is put forward that UV radiation, by increasing body levels of vitamin D, protects against CVD by decreasing the risk of thrombus formation. This hypothesis might explain the seasonal variations in CVD mortality and morbidity which decrease in summer, the higher CVD mortality in higher latitudes, and the inverse relationship between altitude and CVD mortality. It is speculated that this mechanism might involve a direct effect of vitamin D on the platelet, or might be mediated by a change in calcium metabolism.

 

PMID: 7327832 [PubMed - indexed for MEDLINE]

 

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[iii] Int J Epidemiol. 1990 Sep;19(3):559-63.

 

Myocardial infarction is inversely associated with plasma 25-hydroxyvitamin D3 levels: a community-based study .

 

Scragg R, Jackson R, Holdaway IM, Lim T, Beaglehole R.

 

Department of Community Health, University of Auckland , New Zealand .

 

The relation between the plasma level of 25-hydroxyvitamin D3, the main metabolite of sun-induced vitamin D, and myocardial infarction (MI) was investigated in a community-based case-control study. Some 179 MI patients presenting to hospital within 12 hours of the onset of symptoms were individually matched with controls by age, sex and date of blood collection. MI patients had significantly lower mean 25-hydroxyvitamin D3 levels than controls (32.0 versus 35.5 nmol/L; p = 0.017), with the case-control differences being greatest in winter and spring. The relative risk of MI for subjects with 25-hydroxyvitamin D3 levels equal to or above the median was 0.43 (95% confidence limits = 0.27, 0.69) compared to subjects below the median. The decrease in MI risk associated with raised vitamin D3 levels was observed in all seasons. These results provide support for the hypothesis that increased exposure to sunlight is protective against coronary heart disease.

 

PMID: 2262248 [PubMed - indexed for MEDLINE]

 

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[iv] Ann Epidemiol. 1992 Sep;2(5):697-703.

 

 

Plasma 25-hydroxyvitamin D3 and its relation to physical activity and other heart disease risk factors in the general population .

 

Scragg R, Holdaway I, Jackson R, Lim T.

 

Department of Community Health, University of Auckland , New Zeland.

 

The relation between plasma levels of 25-hydroxyvitamin D3, the main metabolite of sun-induced vitamin D, and major coronary heart disease risk factors was examined in 295 men, aged 35 to 64 years, who were randomly sampled from the general population. Men who did regular vigorous leisure-time activity had a mean plasma 25-hydroxyvitamin D3 level that was 4.8 nmol/L (95% confidence limits: 0.1, 9.5) higher than that in inactive men, with the increase greatest in the winter months. Plasma 25-hydroxyvitamin D3 was positively associated with weekly hours of sun exposure (r = 0.27, P < 0.01), and showed a weak inverse association with age (r = -0.12, P < 0.05) and diastolic blood pressure (r = -0.15, P < 0.05), although this latter finding was no longer significant when allowance was made for the effects of age and season on vitamin D levels. In contrast, plasma 25-hydroxyvitamin D3 had no relation with either serum total or high-density-lipoprotein cholesterol levels, body mass index, or cigarette smoking. We hypothesize that vigorous leisure-time activity may protect against coronary heart disease, in part, by increasing body levels of vitamin D.

 

PMID: 1342321 [PubMed - indexed for MEDLINE]

 

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[v] Aust N Z J Med. 1995 Jun;25(3):218-23.

 

Serum 25-hydroxyvitamin D3 is related to physical activity and ethnicity but not obesity in a multicultural workforce.

 

Scragg R, Holdaway I, Singh V, Metcalf P, Baker J, Dryson E.

 

Department of Community Health, University of Auckland , New Zealand .

 

BACKGROUND: Recent research suggests that body vitamin D levels are decreased in coronary heart disease and diabetes, but it is unclear which cardiovascular risk factors are related to vitamin D status. AIMS: To examine the relation between vitamin D status and major cardiovascular risk factors. METHODS: Serum 25-hydroxyvitamin D3, a marker of recent sun exposure and vitamin D status, was measured in 390 New Zealand residents (95 Pacific Islanders, 74 Maori and 221 others mostly of European descent), who were part of a larger cross-sectional survey of a workforce (n = 5677) aged 40-64 years. RESULTS: Serum 25-hydroxyvitamin D3 levels were significantly lower in Pacific Islanders (mean (SE) = 56 (3) nmol/L; p = 0.0001) and Maoris (68 (3) nmol/L; p = 0.036) compared with Europeans (75 (2) nmol/L) after adjusting for age, sex and time of year. Also adjusting for ethnic group, 25-hydroxyvitamin D3 was higher in people doing vigorous (aerobic) leisure physical activities (71 (2) nmol/L; p = 0.0066) and moderate (non-aerobic) activities (68 (3) nmol/L; p = 0.12) compared with those who were inactive (63 (2) nmol/L). However, 25-hydroxyvitamin D3 was unrelated to body mass index, serum lipids, blood pressure or cigarette smoking. CONCLUSIONS: People with increased skin pigmentation, such as Polynesians, and people who are inactive, have decreased body levels of vitamin D; this might partly explain their increased risk of cardiovascular disease.

 

PMID: 7487689 [PubMed - indexed for MEDLINE]

 

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[vi] J Am Coll Cardiol. 2003 Jan 1;41(1):105-12.

Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure?

 

Zittermann A, Schleithoff SS, Tenderich G, Berthold HK, Korfer R, Stehle P.

 

Department of Nutrition Science, University of Bonn , Germany . a.zittermann@uni-bonn.de

 

OBJECTIVES: This study was designed to evaluate the association between vitamin D status and congestive heart failure (CHF). BACKGROUND: Impaired intracellular calcium metabolism is an important factor in the pathogenesis of CHF. The etiology of CHF, however, is not well understood. METHODS: Twenty patients age <50 years and 34 patients age >/=50 years with New York Heart Association classes >/=2 and 34 control subjects age >/=50 years were recruited. N-terminal pro-atrial natriuretic peptide (NT-proANP), a predictor of CHF severity; vitamin D metabolites; and parameters of calcium metabolism were measured in fasting blood samples collected between November 2000 and March 2001. RESULTS: Both groups of CHF patients had markedly increased serum levels of NT-proANP (p < 0.001), increased serum phosphorus levels (p < 0.001), and reduced circulating levels of both 25-hydroxyvitamin D (p < 0.001) and calcitriol (p < 0.001). Albumin-corrected calcium levels were reduced and parathyroid hormone levels were increased in the younger CHF patients compared with the controls (both p values <0.001). Moreover, parathyroid hormone levels tended to be higher in the elderly CHF patients than in the controls (p = 0.074). In a nonlinear regression analysis 25-hydroxyvitamin D and calcitriol were inversely correlated with NT-proANP (r(2) = 0.16; p < 0.001 and r(2) = 0.12; p < 0.01, respectively). The vitamin D genotype at the BmsI restriction site did not differ between the study groups. CONCLUSIONS: The low vitamin D status can explain alterations in mineral metabolism as well as myocardial dysfunction in the CHF patients, and it may therefore be a contributing factor in the pathogenesis of CHF.

 

PMID: 12570952 [PubMed - indexed for MEDLINE]

 

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[vii] J Intern Med. 2003 Apr;253(4):439-46.

Congestive heart failure is associated with the rate of bone loss .

 

Nishio K, Mukae S, Aoki S, Itoh S, Konno N, Ozawa K, Satoh R, Katagiri T.

 

Third Department of Internal Medicine, School of Medicine Showa University, Hatanodai, Shinagawa-ku, Tokyo , Japan . kazukun@ig7.so-net.ne.jp

 

AIMS: To characterize relationships between mineral homeostasis, bone turnover, bone mass, and congestive heart failure (CHF), we evaluated 75 women with mild to moderate CHF. METHODS AND RESULTS: We examined the association in annual rate of change in spinal bone mineral density (BMD) with polymorphism of the vitamin D receptor (VDR) gene. Compared with the control group, the CHF group had reduced left ventricular ejection fraction (LVEF: 68.2 +/- 7.5% vs. 60.2 +/- 12.9%; P = 0.0249), human atrial natriuretic peptide (hANP) was elevated (hANP: 10.7 +/- 4.7 pmol L-1 vs. 25.8 +/- 24.2 pmol L-1; P = 0.001) and had lower peak VO2 (22.3 +/- 7.5 mL kg-1 min-1 vs. 15.8 +/- 7.4 mL kg-1 min-1; P = 0.0429). The CHF patients with the VDR FF genotype had a significantly high annual rate of decrease in BMD. In the CHF patients with the VDR FF genotype, urinary calcium excretion (FECa) was elevated (1.40 +/- 0.91% vs. 2.39 +/- 1.40%; P = 0.028), and serum bone-type alkaline phosphatase (B-ALP) was reduced (62.6 +/- 13.7 IU L-1 vs. 47.0 +/- 18.6 IU L-1; P = 0.0123). Also, FECa was correlated positively with furosemide dose (R = 0.881; P = 0.0087) and hANP concentrations (R = 0.635; P = 0.0147) and negatively with DeltaBMD (R = 0.72; P = 0.044) in the CHF patients with the VDR FF genotype. CONCLUSION: The CHF patients with the VDR FF genotype have higher rates of bone loss. These patients may need to increase their calcium intake and BMD may need to be followed more carefully over time.

 

PMID: 12653873 [PubMed - indexed for MEDLINE]

 

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[viii] Acta Paediatr. 1995 Jan;84(1):106-8.

 

Congestive heart failure caused by vitamin D deficiency?

 

Brunvand L, Haga P, Tangsrud SE, Haug E.

 

Department of Paediatrics, Ulleval Hospital , Oslo , Norway .

 

We describe a child, 3.5 months old, with severe vitamin D deficiency, profound hypocalcaemia, hyperphosphataemia, dilated left ventricle, severely reduced myocardial contractility and congestive heart failure. She also had depressed thyroid function with subnormal thyroxine and non-detectable serum thyrotropin (TSH) levels. The child promptly responded to calcium infusions, conventional anticongestive therapy and calcitriol. She is now 3 years old and received no medication. Myocardial function is normal but she has motor delay. We believe that her transitory congestive heart failure was caused by severe vitamin D deficiency with profound hypocalcaemia.

 

Publication Types:

Case Reports

 

PMID: 7734890 [PubMed - indexed for MEDLINE]

 

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[ix] Monatsschr Kinderheilkd. 1989 Feb;137(2):108-10.

 

[Congestive heart failure in rickets caused by vitamin D deficiency]

 

[Article in German]

 

Gillor A, Groneck P, Kaiser J, Schmitz-Stolbrink A.

 

Kinderkrankenhaus der Stadt Koln .

 

We describe a case of a three and half month old infant presenting with a congestive heart failure due to hypocalcemic cardiomyopathy. Vitamin D deficiency rickets was found to be the cause for the hypocalcemia. The heart failure responded promptly to adequate Calcium therapy accompanied by usual anticongestive therapy.

 

Publication Types:

Case Reports

 

PMID: 2716737 [PubMed - indexed for MEDLINE]

 

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[x] Pediatrie. 1993;48(7-8):547-9.

 

[A severe form of vitamin D deficiency with hypocalcemic cardiomyopathy]

 

[Article in French]

 

Yaseen H, Maragnes P, Gandon-Laloum S, Bensaid P, N'Guyen B, Ricaud D, Lecacheux C.

 

Unite de reanimation infantile, CHU Cote de Nacre, France .

 

The authors report on a case of cardiomyopathy with congestive heart failure in an infant with severe hypocalcemia related to vitamin D deficient rickets. The heart failure was successfully treated with calcium gluconate and vitamin D, associated with dobutamide.

 

Publication Types:

Case Reports

 

PMID: 8165115 [PubMed - indexed for MEDLINE]

 

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[xi] Hypertension. 1997 Aug;30(2 Pt 1):150-6.

 

[Link to free copy of full text of article]

Comment in:

Hypertension. 1998 Feb;31(2):719.

Ultraviolet light may contribute to geographic and racial blood pressure differences.

 

Rostand SG.

 

Nephrology Research and Training Center, Department of Medicine, The University of Alabama at Birmingham , 35294, USA . srostand@nrtc.dom.uab.edu

 

Mean systolic and diastolic pressures and the prevalence of hypertension vary throughout the world. Published data suggest a linear rise in blood pressure at increasing distances from the equator. Similarly, blood pressure is higher in winter than summer. Blood pressure also is affected by variations in skin pigmentation. Altered calcium, vitamin D, and parathyroid hormone status is associated with hypertension and may vary with latitude and season. Since changes in UV light affect vitamin D and parathyroid hormone status and UV light intensity are influenced by seasonal change and latitude, these disparate observations suggest an association between blood pressure and ultraviolet light. This discussion presents the hypothesis that reduced epidermal vitamin D3 photosynthesis associated with high skin melanin content and/or decreased UV light intensity at distances from the equator, alone or when coupled with decreased dietary calcium and vitamin D, may be associated with reduced vitamin D stores and increased parathyroid hormone secretion. These changes may stimulate growth of vascular smooth muscle and enhance its contractility by affecting intracellular calcium, adrenergic responsiveness, and/or endothelial function. Thus, UV light intensity and efficiency of epidermal vitamin D3 photosynthesis may contribute to geographic and racial variability in blood pressure and the prevalence of hypertension.

 

Publication Types:

Review

Review, Tutorial

 

PMID: 9260973 [PubMed - indexed for MEDLINE]

 

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[xii] Lancet. 1998 Aug 29;352(9129):709-10.

 

Ultraviolet B and blood pressure.

 

Krause R, Buhring M, Hopfenmuller W, Holick MF, Sharma AM.

 

Publication Types:

Clinical Trial

Letter

Randomized Controlled Trial

 

PMID: 9728997 [PubMed - indexed for MEDLINE]

 

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[xiii] J Clin Endocrinol Metab. 2001 Apr;86(4):1633-7.

[link to free text of this article]

 

Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women.

 

Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C.

 

Institute of Clinical Osteology Gustav Pommer , Clinic der Furstenhof, 31812 Bad Pyrmont, Germany . iko-pyrmont@t-online.de

 

Calcium supplementation is effective in reducing blood pressure in various states of hypertension, including pregnancy-induced hypertension and preeclampsia. In addition, calcitropic hormones are associated with blood pressure. The hypothesis is that short-term therapy with calcium and vitamin D(3) may improve blood pressure as well as secondary hyperparathyroidism more effectively than calcium monotherapy. The effects of 8 weeks of supplementation with vitamin D(3) (cholecalciferol) and calcium on blood pressure and biochemical measures of bone metabolism were studied. The sample consisted of 148 women (mean +/- SD age, 74 +/- 1 yr) with a 25-hydroxycholecalciferol (25OHD(3)) level below 50 nmol/L. They received either 1200 mg calcium plus 800 IU vitamin D(3) or 1200 mg calcium/day. We measured intact PTH, 25OHD(3), 1,25-dihydroxyvitamin D(3), blood pressure, and heart rate before and after treatment. Compared with calcium, supplementation with vitamin D(3) and calcium resulted in an increase in serum 25OHD(3) of 72% (P < 0.01), a decrease in serum PTH of 17% (P = 0.04), a decrease in systolic blood pressure (SBP) of 9.3% (P = 0.02), and a decrease in heart rate of 5.4% (P = 0.02). Sixty subjects (81%) in the vitamin D(3) and calcium group compared with 35 (47%) subjects in the calcium group showed a decrease in SBP of 5 mm Hg or more (P = 0.04). No statistically significant difference was observed in the diastolic blood pressures of the calcium-treated and calcium- plus vitamin D(3)-treated groups (P = 0.10). Pearson coefficients of correlation between the change in PTH and the change in SBP were 0.49 (P < 0.01) for the vitamin D(3) plus calcium group and 0.23 (P < 0.01) for the calcium group. A short-term supplementation with vitamin D(3) and calcium is more effective in reducing SBP than calcium alone. Inadequate vitamin D(3) and calcium intake could play a contributory role in the pathogenesis and progression of hypertension and cardiovascular disease in elderly women.

 

Publication Types:

Clinical Trial

Randomized Controlled Trial

 

PMID: 11297596 [PubMed - indexed for MEDLINE]

 

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