Increased Risk of Cardiovascular Disease with Vitamin D Deficiency

J. Partsch/ L. Pettigrew 1

Increased Risk of Cardiovascular Disease with Vitamin D Deficiency What is Cardiovascular Surgical procedures can Disease: aid in repairing arterial walls An estimated and increase blood flow back to 800,000,000, American adults, the heart. However, the long have one or more types of term reduced flow of oxygen Cardiovascular Disease (1). and nutrients to the heart can That equates to one out of cause permanent damage to every three people in the U.S. the heart muscle and affect the who are living with some sort function of the heart forever. of heart disease. The common risk factors Cardiovascular disease (CVD) known to lead to CVD are affects the heart muscle, the tobacco use, hypertension, arteries and the veins. The diabetes, physical inactivity, arteries supply blood to the age, family history, and heart. Over time, the arteries gender. The emerging risk become less elastic and harden, factors for CVD are increased due to the formation of plaque. C- reactive protein levels, This formation causes increased thrombosis and inadequate blood flow to the fibrinogen, heart. As plaque accumulates in hyperhomocyteinemia, and the arteries, there becomes increased Lp(a) and LDL limited or complete blockage of subclasses levels. The blood flow to the heart. When populations most at risk for blood flow is reduced or ceases developing CVD are middle to be carried to the heart, it aged to elderly adults, over the also affects the flow of oxygen age of 60. The best preventive and nutrients being transported measure against CVD is to the heart. This reduced flow maintaining a healthy lifestyle of blood, oxygen and nutrients of frequent aerobic exercise to the heart leads to permanent and a diet rich in essential damage of the actual heart vitamins, like vitamin D, and muscle itself. unsaturated fats. (1)

What is Vitamin D: Vitamin D is essential for proper function of the human body. It is a fat-soluble vitamin. The body endogenously absorbs vitamin D through limited foods sources like fatty fish and fortified J. Partsch/ L. Pettigrew 2 foods, which include breakfast Vitamin D is linked to CVD: cereals and milk. Vitamin D is The linkage between exogenously absorbed through vitamin D levels and type B UV light. cardiovascular disease is through the rennin- angiotensin system. The rennin angiotension system regulates blood pressure and water fluid balance in the body. When plasma serum levels are low in vitamin D, 25 hydroxyvitamin D, the body releases higher levels of rennin, Once absorbed, via which causes arterial endogenously or exogenously, constriction. Low levels of the inactive form of vitamin D vitamin D cause is hydroxylated in the liver and hyperparathyroidism, which is a changes to its active form 1, 25 hormone that releases too much hydroxyvitamin D using a calcium into the bloodstream. variety of organs including the Decreased vitamin D kidney. The active form of levels in the body have been vitamin D is then released into linked with Hyperparathyroidism the blood stream. and potentially lead to The well-known functions devastating effects and increase of vitamin D are to maintain the risk for cardiovascular bone and muscle health by disease. regulating calcium metabolism, insulin production and functioning as a hormone (3). Maintaining Calcium levels is extremely important, because calcium is vital for nerves and muscles to function. The emerging functions of vitamin D are for arterial wall smooth muscle cell proliferation, reduced inflammation, vascular calcification and blood pressure. Only excessive oral consumption of vitamin D rich foods leads to toxicity and does A decrease in 25(OH) D levels not occur with excessive sun will lead to an increase of the exposure. (3) parathyroid hormone levels. An increase of these hormone levels will in turn create a J. Partsch/ L. Pettigrew 3 deficiency in Vitamin D, which Measuring Vitamin D Levels: reduces intestinal calcium The suggested plasma absorption. When there is a serum vitamin D levels that reduction of intestinal calcium reduce the risk of arterial absorption, it triggers the constriction are 37 ng/ mL or parathyroid hormone to release, greater; these are suggested to which repairs the levels of lead to additional health calcium. This occurs because benefits including reducing the calcium is obtained from the risk for CVD. The defined bones and stimulates kidney vitamin D levels that increase production of 25(OH) D. In risk are suggested to be 20 addition to this, levels of vitamin ng/mL or lower. To determine D in the body become lowered the level of risk of CVD from overall. low Vitamin D Serum levels, a Inflammation causes an standard blood test prescribed increase in calcium blood levels by a physician should be leading to inflammation of requested. (4) arterial walls. The decrease of Vitamin D levels increases the Correlated studies: risk of calcification of heart Developing Cardiovascular valves due to this increased Disease Risk Factors: level of calcium in the blood A 2007 study published in stream. Also, insulin resistance the Archives of International has been observed with Medicine reported an association increased PTH levels causing an between vitamin D and increase in the risk of cardiovascular disease risk developing diabetes…a well factors. In the study, 7,186 known risk factor for CVD. A low men and 7,902 women over the level of 25(OH) D along with age of twenty had their blood increased PTH levels increases measured for levels of 25(OH) inflammation and increases the D. The mean of 25 (OH) D risk of cardiovascular disease. levels was 30 ng/ml. The (3) current recommended levels of serum 25 (OH) D are based on levels needed to maintain optimum bone health and prevent rickets, but does not address the amount of vitamin D to minimize the risk of cardiovascular disease. The research hypothesized that individuals with reduced 25(OH) D levels would have an increased risk of cardiovascular J. Partsch/ L. Pettigrew 4 disease. The participants cardiovascular disease. Both studied were currently not male and females that had a taking vitamin D supplements. BMI greater > 30 are 229% The distribution of vitamin D more likely to develop levels in the body may have cardiovascular disease. been skewed in some Participants with a history of participants due to varying diabetes and triglyceride levels latitudes altering the > 150 mg/dl are susceptible to measurements slightly of the 25 inheriting risk of cardiovascular (OH) D collected and analyzed. disease. The study also found It was found that higher levels participants with non-HDL of UV light exposure were a cholesterol levels >150 or total better predictor for having cholesterol levels >240 are less higher levels of vitamin D likely to developing risk factors absorption. The blood analyses of cardiovascular disease. found 25(OH) D levels were Overall, an increased lower in women, racial blood pressure, history of minorities, and people with diabetes, BMI >30 and high obesity, hypertension, diabetics triglyceride levels lead to and elderly older than sixty participants with greater risk of years of age. developing risk of cardiovascular The study included disease. However, the measured levels of the correlation between vitamin D participants’ BMI, blood linked and risk factors for pressure and 25(OH) D. Data developing cardiovascular was collected from the disease show that participants participants based on age, with increased levels of vitamin ethnicity, sex, blood pressure D lower the risk of developing level, history of hypertension, cardiovascular disease. (4) blood glucose, lipid levels, history of diabetes, and body mass index. The participants’ blood samples were measured for blood glucose, total cholesterol, serum triglyceride, Cardiovascular Outcomes: serum albumin and glomerular A 2008 article published in filtration rate. Circulation demonstrated a The results of the study strong link between Vitamin D found that participants with high deficiency and an increased risk blood pressure, a systolic for developing cardiovascular pressure greater than or equal disease. The epidemiological to 140, and a diastolic pressure study, from the Framingham greater than or equal to 90, Offspring was started in 1971, were at 30% increased risk for J. Partsch/ L. Pettigrew 5 which followed a group of white estimate of sun exposure, males and females linked to the physical activity levels, and Boston University Medical detailed food frequency Center and Tufts-New England questionnaires. Medical center. The participants The results first analyzed were studied based on natural the risk for outcomes of cardiac life progression of diseases events, which included linked to Vitamin D levels. myocardial infarction, coronary Between 1996 and 2001,a total insufficiency, angina, stroke, of 1,739 participants returned transient ischemic attack, for observation. They had peripheral claudicating or heart additional laboratory and health failure. The results were based assessments tests that on the true risk of experiencing pertained to cardiovascular a cardiac event with age and health. sex as the control factors. The Each participant was findings were significant, having assessed for common risk a 66% increase in risk after factors linked with adjustment for clinical cardiovascular disease, covariates and CRP levels of a including: age, gender, blood cardiac event when the pressure, and blood glucose; participant had 25 (OH) D levels along with blood vitamin D below <15ng/mL. The risk of a serum levels. The samples cardiac event occurring further collected were analyzed based increased to 88% with low 25 on the following standards: (OH) D, <10 ng/Ml. The second Hypertension, > 140mm Hg, aspect of the research analyzed diastolic blood pressure, > the added risk of hypertension 90mm Hg, and blood sugar accompanying 25 (OH) D levels levels, >126 mg/dL. Vitamin D, on the occurrence of a cardiac 25 dihydroxyvitamin D (25 (OH) event. The results found in D), was tested based a participants with 25 (OH) D determined scale of: <10ng/mL levels of <15ng/mL the risk was as low, > 15ng/mL as medium dramatically higher, increasing and > 30ng/mL as high and from 66%, in participants optimal levels. The serum 25 without hypertension, to 219%, (OH) D was used as the most in participants with accurate reading of Vitamin D hypertension. levels in the body as it represents both the endogenous and exogenous levels absorbed by dietary intake and exposure to sunlight. The other basic health assessments included a lifestyle J. Partsch/ L. Pettigrew 6

The risk of a cardiac event stroke, heart failure, and acute increased another 24% to 243% myocardial infraction. risk of a cardiac event with Overall, the study found a participants having both 25 nonlinear relationship of (OH) D levels <10ng/mL and cardiovascular disease and low hypertension. The results found vitamin D serum levels below 15 a linear trend with increased to 20 ng/mL; showing a strong risk of a cardiac event with linkage of risk for heart disease hypertension and decreased 25 and cardiac events with low (OH) D levels; the analysis vitamin D levels. (5) demonstrates that the participants with the Conclusion: combination of hypertension The conclusion to the and low 25 (OH) D levels are at studies showed that diets very high risk for experiencing a including adequate vitamin D cardiac event. levels, reduces arterial The study found after constriction and release of adjustment for conventional rennin; thus ultimately reducing cardiovascular risk factors, that the risk of CVD. The studies also there was still a significant link found that patients with low between 25 (OH) D and an plasma serum vitamin D levels increased risk for cardiovascular showed overall health disease. The findings indicate improvement and had reduced that 28% of participants had risk of CVD. (2,3, 4, 5, and 6) serum average levels of 25 (OH) Recommendations for D of 19.6ng/mL; this indicated a further studies: number lower than optimal The studies support vitamin D levels but still within further long-term research adequate range, with only 9% surrounding Vitamin D and its below 10 ng/mL. The study also relationship to the reduction of found that the participants with CVD and arterial health, hypertension had a 2-fold including constriction and increased risk for cardiovascular proliferation. The negative disease if low vitamin D serum aspect of the studies showed no levels accompanied the current epidemiological research hypertension. It was observed surrounding Vitamin D and CVD that low levels of vitamin D specifically, and did not take occurring before cardiovascular into account different ethnicities problems had a high linkage to and populations with no prior an increased risk of developing kidney damage or failure heart problems more rapidly. previous to the study. These heart problems included J. Partsch/ L. Pettigrew 7

List of Reference 4. Martin D, Myles W, Pan D, et 1. American Heart Association. al. Prevalence of Cardiovascular www.americanheart.org. 2009 Risk Factors and the Serum Levels of the 25 2. Hur SJ, Kim DM, Lim KH, et Hydroxyvitamin-D in the United al. Vitamin D Levels and Their States. AMA. 2007; 167: 1159- Relationship with Cardiac 1165. Biomarkers in Chronic Hemodialysis Patients. J of 5. Wang TJ, Pencina MJ, Booth Korean Medicine.2009; 24(1): SL, et al. Vitamin D Deficiency 109-114 and Risk of Cardiovascular Disease. AHA. 2008; 117:1-9 3. Lee JH, Bell D, et al. Vitamin D Deficiency: An important, 6. Wang AY, Lam CW, Common, and Easily Treatable Sanderson JE, et al. Serum 25- Cardiovascular Risk Factor. Hydroxyvitamin D and Journal of American College of Cardiovascular Outcomes in Cardio, 2008; 52: 1949-1956 Chronic Peritoneal Dialysis: a 3- y prospective cohort study. The American Journal of Clinical Nutrition. 2008; 87: 1631-1638.