Download - Vit d and cv risks
VITAMIN D DEFICIENCY&
CARDIOVASCULAR RISKS
HYPE OR REALITY
Dr. Dibbendhu KhanraDr. A. Talukdar
Medical College, Kolkata
OBJECTIVE
Introduction Vit D: Metabolism & MOA Cardiovascular risks & mortality Deficiency status/ Treatment
recommendation Our experience and Conclusion
A PubMed search with “vitamin D” and selecting articles published in the past two years resulted in more than 2,864 hits
Vitamin D
The Nobel prize for chemistry for 1928 was awarded to Adolf Windaus, the first person to receive an award mentioning ‘vitamins’. What was the contribution Windaus made to our knowledge of vitamins that deserved the highest scientific accolade?
(New York Times 1978)
Superstar
Heart,, DMCancer, Obesity, RA, TB, Depression..etc
“SUNSHINEVITAMIN”
SECOND MASSENGER
BIOCHEMISTRY
MOLECULAR BIOLOGY
VIT D RECEPTOR
Also- Brain- Beta cells- Adipose tissue
Status of Vit D hyped over time
Li et al, Tomaschitz et al, Forman et al
Apoptosis Fibrosis Vascular SMC hypertrophy
calcium effect on insulin secretionexpression of the insulin receptor
enhancing insulin responsiveness for glucose transport
hsCRP, IL10MMP9
UVB radiation from tanning 3 times a week for 3 months led to a nearly 200% increase in
25(OH)D levels and a 6 mmHg decrease in both systolic and diastolic blood pressure Krause R. Lancet 1998
Vit D deficiency & hypertension
In the NHANES III study, the average SBP was nearly 3 mm Hg lower in subjects with
the highest quartile of 25(OH)D compared to subjects in the lowest quartile Scragg R. Third National Health and Nutrition Examination Survey. Am J Hypertens 2007
Vit D deficiency & DM
A study of >10,000 Finnish children who were given 2,000 IU vitamin D3 per day
during the first year of life demonstrated a 78% reduced risk of type 1 diabetes over a 30-
year follow-up. Subsequently, this finding was confirmed by a meta-analysis of 5
observational studies in England. Hyppönen E, Lancet 2001, Zipitis CS Arch Dis Child 2008
Daily intake of >800 IU of vitamin D compared with <400 IU vitamin D reduced the risk
of T2DM by nearly one-third. It is hoped that starting vitamin D supplementation soon after
birth may be a protective strategy against the development of type 1 diabetes. Pittas AG. Diabetes Care 2006, Rifkin J. Pract Diabetol 2009
Low vitamin D levels have also been shown to be predictive of the future development
of type 2 diabetes. Increasing vitamin D serum levels to normal led to a 55% relative
reduction in the risk of developing type 2 diabetes. Forouohi NG. Diabetes 2008, Parker J. Maturitas 2010
In high-risk type 2 diabetic patients with elevated UAER, low levels of vitamin D are
associated with asymptomatic CAD. Joergensen . Diabetes Care 2011
Administration of 1,25(OH)2Din the setting of vitamin D deficiency has been shown to
down-regulate inflammatory biomarkers such as CRP.
Schleithoff SS. Am J Clin Nutr 2006
In a 10-year follow-up of 18,225 men in the Health Professionals Follow-up Study,
low levels of 25(OH)D were associated with higher risk of myocardial infarction, even
after controlling for other CHD risk factors.
Giovannucci E. Arch Intern Med 2008
In an analysis of 27,000 patients from the Inter-mountain Healthcare System, the
prevalence of vitamin D deficiency (<30 ng/ml) was 60%; and vitamin D deficiency was
associated with highly significant (p <0.0001) increases in the prevalence of dyslipidemia. Anderson JL. Am J Cardiol 2010
A recently published multicenter study evaluating patients admitted with acute coronary
syndromes found that 96% of these patients had abnormal 25(OH)D levels<30 ng/ml.
Lee JH. Am J Cardiol 2011
Vit D deficiency & ACS/IHD
Vit D deficiency & depression
vitamin D concentrations have been found to be low in patients with mood disorders,
including depression. Kalueff A. CNS Neurol Disord Drug Targets 2006
In data from the NHANES III study, in nearly 8,000 noninstitutionalized U.S. residents,
the likelihood of having depression was significantly higher among those with vitamin D
deficiency. Ganji V. Int Arch Med 2010
Vit D deficiency & Hemodialysis
Vit D deficiency & mortality
After stardom comes controversy!
Vit D deficiency & controversies
Prospective trials of vitamin D and diabetes to date were either too small or used
inadequate amounts of vitamin D. Schwallenberg G Can Fam Phys
2008 Another meta-analysis of 8 randomized trials showed statistically nonsignificant reduction
in CV disease risk with vitamin D supplementation at moderate to high doses
(approximately 1,000 IU daily) Wang L. Ann Intern Med 2010
A very recent meta-analysis of 51 studies found that the effects of vitamin D were
nonsignificant on the endpoints of death, myocardial infarction, and stroke. Elamin MB. Am J Cardiol 2011
In a meta-analysis of 10 trials, supplementation with vitamin D only nonsignificantly
reduced systolic blood pressure by 2 mm Hg and did not reduce diastolic blood pressure DerSimonian R. Control Clin Trials 2012
Will the hype regarding thisvitamin/hormone will stand the test of time?
Will this ‘jack of all trade’ vitamin D pass the rigors of randomized controlled trials?
Will vitamin D be another vitamin E, C, or folic acid, or will the results be more similar to those with omega-3
fatty acids (or better)?
VITAMIN D: HYPE OR REALITY
New challenge is on the way for vitamin D
SELECTED FOOD SOURCES OF VIT D
Food IU/serving
Cod Liver Oil, (1 tablespoon) 1,360
Wild Salmon, (3 oz) 600-1,000
Farmed Salmon, (3 oz) 100-250
Mackerel, (3 oz) 345
Tuna fish in oil, (3 oz) 200
Sardines in oil, (1 oz) 250
Milk, (1 cup) 98
NIH
TREATMENT RECOMMENDATIONS FORVITAMIN D DEFICIENCY
Vitamin D Deficiency25(OH)D < 20 ng/dL
60,000 IU of D2 or D3 Per Week X 8 weeks
Maintenance Therapy
60,000 IU of D2 Every month
Recheck 25(OH)D in 3 to 6 months
Statin myopathy Metformin induced peripheral neuropathy
SPECIFIC OBJECTIVES OF THE STUDY
1. To assess serum 25-Hydroxy vitamin D levels in Ischemic heart disease
patients and their age, sex matched controls
2. To compare the vitamin D status between Ischemic heart disease cases and the
control group and see if there is any relationship between vitamin D deficiency and
Ischemic heart disease
3. To explore for any correlation between vitamin D levels and other
conventional cardiovascular risk factors in Ischemic heart disease
A STUDY OF VITAMIN D LEVELS IN PATIENTS OF ISCHEMIC HEART DISEASE WITH SPECIAL REFERENCE TO ITS ROLE AS A
CARDIOVASCULAR RISK FACTOR
EXCLUSION CRITERIA
a) All known/diagnosed patients of DM/on OHA/
insulin therapy
b) All known/ suspected patients of osteomalacia
c) Patients suffering from neoplastic disease
d) Patients older than 70 years and younger than
30 years.
e) Patients of chronic renal failure
INCLUSION CRITERIA
nondiabetic patients between age group of
30-70 years seeking medical attention with the
complaint of acute chest pain/ chest
discomfort/ dyspnea/ orthopnea etc, together
with either elevated serum cardiac biomarkers/
Echocardiographic evidence of new onset
regional wall motion abnormality of left
ventricle/ specific ECG changes consistent with
myocardial ischemia/infarction. Along with
this symptomatic patients of chronic ischemic
heart disease with either documented TMT test
positive ECG or prior history of acute
coronary syndrome (STEMI/ NSTEMI) as
evident by ECG changes of old infarction will
be taken.
PARAMETERS
a) Serum 25(OH) vitamin D levels.
b) Serum lipid profile.
c) Fasting and postprandial blood sugar
CONCLUSION
Vit D levels correlate with CV Disease
Supplementation possibly may improve CV Outcomes but trials are needed
Vit D levels should be obtained in CV patients and supplementation considered, especially if treated with Statins
Thank you