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STATE-OF-THE-ART PAPER

Vitamin D Deficiency

An Important, Common, and Easily Treatable Cardiovascular Risk Factor?

John H. Lee, MD^_*, James H. O'Keefe, MD^_*,_*, David Bell, MD, Donald D. Hensrud, MD, MPH and Michael F. Holick, MD, PhD

^_* Mid America Heart Institute and University of Missouri, Kansas City, Missouri
Southside Endocrinology, Birmingham, Alabama
Mayo Clinic, Rochester, Minnesota
Boston University Medical Center, Boston, Massachusetts

Manuscript received June 4, 2008; revised manuscript received August 6, 2008, accepted August 13, 2008.

^_* Reprint requests and correspondence: Dr. James H. O'Keefe, 4330 Wornall Road, Suite 2000, Kansas City, Missouri 64111 (Email: jhokeefe{at}cc-pc.com).

Vitamin D deficiency is a highly prevalent condition, present in approximately 30% to 50% of the general population. A growing body of data suggests that low 25-hydroxyvitamin D levels may adversely affect cardiovascular health. Vitamin D deficiency activates the renin-angiotensin-aldosterone system and can predispose to hypertension and left ventricular hypertrophy. Additionally, vitamin D deficiency causes an increase in parathyroid hormone, which increases insulin resistance and is associated with diabetes, hypertension, inflammation, and increased cardiovascular risk. Epidemiologic studies have associated low 25-hydroxyvitamin D levels with coronary risk factors and adverse cardiovascular outcomes. Vitamin D supplementation is simple, safe, and inexpensive. Large randomized controlled trials are needed to firmly establish the relevance of vitamin D status to cardiovascular health. In the meanwhile, monitoring serum 25-hydroxyvitamin D levels and correction of vitamin D deficiency is indicated for optimization of musculoskeletal and general health.

Key Words: vitamin D • 25-hydroxyvitamin D • calcium • coronary disease prevention • hypertension • diabetes

Abbreviations and Acronyms   25(OH)D = 25-hydroxyvitamin D   CV = cardiovascular   MI = myocardial infarction   PTH = parathyroid hormone   UVB = ultraviolet B   VDR = vitamin D receptor

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