CORRESPONDENCE: LETTER TO THE EDITOR
Lower Vitamin D Status May Explain the Higher Prevalence of Peripheral Arterial Disease Among African Americans
William B. Grant, PhD*
* Sunlight, Nutrition, and Health Research Center (SUNARC), P.O. Box 641603, San Francisco, California 94164-1603 (Email: wbgrant{at}infionline.net).
The report that the etiology of dramatically higher prevalence of peripheral arterial disease (PAD) among African Americans cannot be explained by traditional or novel cardiovascular disease risk markers (1) suggests that other factors are involved. A factor overlooked in the study by Ix et al. (1) that may explain the higher prevalence is lower vitamin D status for African Americans. Hypovitaminosis D is present in a substantial proportion of the African-American population due to dark skin, low oral intake of vitamin D, and possibly higher body fat levels (2,3).
Observational evidence linking low serum 25-hydroxyvitamin D to increased risk of PAD was recently reported based on data from 4,839 participants of the National Health and Nutrition Examination Survey 2001 to 2004. For each 10 ng/ml lower 25 (OH) vitamin D level, the multivariable-adjusted prevalence ratio of PAD was 1.35 (95% confidence interval: 1.15 to 1.59) (4).
In addition, there is indirect evidence of a link. Diabetes mellitus is a risk factor for PAD (1), and those with diabetes mellitus have an increased risk of PAD (5). Those with PAD often have osteoporosis (6). Cardiovascular disease, another risk factor for PAD (1), has now been linked to low vitamin D as well (7).
Further testing of this hypothesis could be done via randomized controlled trials, perhaps based on a post hoc analysis of an existing trial, for example (8). If the hypothesis is correct, increasing serum calcidiol levels for those at risk of PAD would reduce the risk and severity of PAD, and have many other health benefits as well (9). Additional support for a role of vitamin D in reducing the risk of PAD appeared recently (10).
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Please note: The author receives funding from the UV Foundation (McLean, Virginia), the Vitamin D Society (Canada), and the European Sunlight Association (Brussels).
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References
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1. Ix JH, Allison MA, Denenberg JO, et al. Novel cardiovascular risk factors do not completely explain the higher prevalence of peripheral arterial disease among African Americans. The San Diego Population study. J Am Coll Cardiol 2008;51:2347-2354.[Abstract/Free Full Text]2. Grant WB. Lower vitamin-D production from solar ultraviolet-B irradiance may explain some differences in cancer survival rates J Natl Med Assoc 2006;98:357-364.[Medline] 3. Egan KM, Signorello LB, Munro HM, et al. Vitamin D insufficiency among African-Americans in the southeastern United States: implications for cancer disparities (United States) Cancer Causes Control 2008;19:527-535.[CrossRef][Web of Science][Medline] 4. Melamed ML, Muntner P, Michos ED, et al. Serum 25-hydroxyvitamin D levels and the prevalence of peripheral arterial disease: results from NHANES 2001 to 2004 Arterioscler Thromb Vasc Biol 2008;28:1179-1185.[Abstract/Free Full Text] 5. Knekt P, Laaksonen M, Mattila C, et al. Serum vitamin D and subsequent occurrence of type 2 diabetes Epidemiology 2008;19:666-671.[CrossRef][Web of Science][Medline] 6. Mangiafico RA, Russo E, Riccobene S, et al. Increased prevalence of peripheral arterial disease in osteoporotic postmenopausal women J Bone Miner Metab 2006;24:125-131.[CrossRef][Web of Science][Medline] 7. Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease Circulation 2008;117:503-511.[Abstract/Free Full Text] 8. Lappe JM, Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial Am J Clin Nutr 2007;85:1586-1591.[Abstract/Free Full Text] 9. Holick MF. Vitamin D deficiency N Engl J Med 2007;357:266-281.[Free Full Text] 10. Melamed ML, Muntner P, Michos ED, et al. Serum 25-hydroxyvitamin D levels and the prevalence of peripheral arterial disease: results from NHANES 2001 to 2004 Arterioscler Thromb Vasc Biol 2008;28:1179-1185.[Abstract/Free Full Text]
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