Technical comment

Vitamin D deficiency and cardiovascular disease

Publication Date: 28.07.2013
Swiss Med Wkly. 2013;143:w13821

Saeed Ahmed, Supawat Ratanapo, Wonngarm Kittanamongkolchai, Wisit Cheungpasitporn, Promporn Suksaranjit, Daych Chongnarungsin

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We read with interest the article by Guessous et al. [1]. The author described an excellent study on vitamin D levels and associated factors. The author mentioned the association between vitamin D and cardiovascular disease, which we found fascinating, and we would like to emphasise the topic. Cardiovascular disease (CVD) is the leading cause of death in the United States. There is an increasing interest in using vitamin D levels as a novel marker for CVD [2], because epidemiological data have shown a strong correlation between the risk of CVD and vitamin D deficiency. A cross-sectional analysis of the NHANES database showed a higher prevalence of CVD among individuals with low levels of 25-hydroxy [25(OH)] vitamin D [3]. The mechanism leading to the increased cardiovascular risk is not clearly understood; however, patients with vitamin D deficiency were found to have upregulation of the renin angiotensin aldosterone system (RAAS). The relationship between vitamin D deficiency and upregulation of the RAAS was also found in a large epidemiological study of 3,000 patients [4]. A recent meta-analysis involving 19 prospective studies (6,123 CVD cases) also showed increased CVD risk in patients with serum 25(OH)-vitamin D levels of 20–60 nmol/L [5].

Though multiple lines of evidence suggest a link between low vitamin D levels and increased risk of CVD, multiple interventional trials have failed to reveal any significant benefit of vitamin D supplementation [6–7]. There is also no benefit of vitamin D supplementation in improvement of diastolic function and regression of left ventricular hypertrophy [8]. Further studies are needed to establish the effect of vitamin D supplementation on CVD risk.

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Correspondence: Wisit Cheungpasitporn, MD, Department of Medicine, Bassett Medical Center, USA-Cooperstown, New York 13326, wisit.cheungpasitporn[at]


1 Guessous I, Dudler V, Glatz N, Theler JM, Zoller O, Paccaud F, et al. Vitamin D levels and associated factors: a population-based study in Switzerland. Swiss Med Wkly. 2012;142:w13719 .

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3 Martins D, Wolf M, Pan D, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007;167:1159–65.

4 Tomaschitz A, Pilz S, Ritz E, et al. Independent association between 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D and the renin-angiotensin system: the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. Clin Chim Acta. 2010;411:1354–60.

5 Wang L, Song Y, Manson JE, Pilz S, März W, Michaëlsson K, et al. Circulating 25-hydroxy-vitamin d and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes. 2012;5(6):819–29. Epub 2012 Nov 13.

6 Pittas AG, Chung M, Trikalinos T, Mitri J, Brendel M, Patel K, et al. Systematic review: Vitamin D and cardiometabolic outcomes. Ann Intern Med. 2010;152(5):307.

7 Elamin MB, Abu Elnour NO, Elamin KB, Fatourechi MM, Alkatib AA, et al. Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2011; 96(7):1931.

8 Thadhani R, Appelbaum E, Pritchett Y, et al. Vitamin D Therapy and Cardiac Structure and Function in Patients With Chronic Kidney Disease: The PRIMO Randomized Controlled Trial. JAMA. 2012;307(7):674–84.

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