the role of vitamin in heart health and cardiovascular...
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The role of Vitamin in heart health
Dr Sohail Mushtaq [email protected] @SohailMushtaq
and cardiovascular disease prevention
Vitamin D • majority of vit D synthesised in the skin from action
of UVB radiation (290-320nm) • synthesis during summer months must provide for
vit D needs during winter • in UK little/no synthesis occurs in skin between Oct
and March – light with correct wavelength does not reach Earth surface
ergocalciferol
Alexandra Schmid, and Barbara Walther Adv Nutr 2013;4:453-462
©2013 by American Society for Nutrition
cholecalciferol
Food sources contributing to dietary vitamin D in UK
meat + meat products 30%
fat spreads 19%
fish + fish products 17%
cereals 13%
eggs + egg dishes 13%
milk + milk products 5%
National Diet and Nutrition Survey. Rolling Programme (2008/2009 – 2011/12) : Age group: 19-64
Vitamin D deficiency • vitamin D deficiency is becoming more common
in developed countries • in UK, the prevalence of vitamin D deficiency in
adults is around 40% in winter (NDNS 2008-2011)
Vitamin D deficiency
Pearce SH ,Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ 2010
Vitamin D deficiency • in adults may be due to:
– extensive covering with clothing – skin colour – failure to spend time outdoors – use of anti-UVB sunscreens results in decreased skin
synthesis of vitamin D – inadequate diet – link with obesity?
• in adults over 65, an inadequate diet, reduced gut absorption and reduced mobility increase risk
Preventing vitamin D deficiency
DOHrecommenda-ons:• Allinfantsandchildrenunder5yearsshouldtakesupplements–atleast280IU(7µg)daily
• Allpregnant/breasIeedingwomenshouldtake400IU(10µg)vitaminDsupplementsdaily
• People aged 65 years and over should also take a daily supplement containing 400IU(10µg)of vitamin D
Gropper et al. (2013)
Vitamin D receptor (VDR)
Vitamin D receptors are widely dispersed
Vitamin D and CVD risk
OBSERVATIONAL STUDIES: Forest plot of all meta-analyses stratified by measured biomarker with relative risk as type of metric.
Theodoratou E et al. BMJ 2014;348:bmj.g2035
©2014 by British Medical Journal Publishing Group
Ku et al. World J Cardiol 2013; 5(9): 337-346
STROKE: Forest plots including on-trial only results from the RECORD.
John A Ford et al. Am J Clin Nutr 2014;100:746-755 ©2014 by American Society for Nutrition
MI: Forest plots including on-trial only results from the RECORD.
John A Ford et al. Am J Clin Nutr 2014;100:746-755 ©2014 by American Society for Nutrition
HEART FAILURE: Forest plots including on-trial only results from the RECORD. Squares or diamonds indicate the point estimate of the study or overall effect.
John A Ford et al. Am J Clin Nutr 2014;100:746-755 ©2014 by American Society for Nutrition
Pfeiffer et al. J Clin Endocrinol Metab. 2001 Apr;86(4):1633-7.
Mechanisms of action
Potential mechanisms
Ku et al. World J Cardiol 2013; 5(9): 337-346
Conclusions and future perspectives • observational studies report an inverse association between serum
25(OH)D concentration and CVD risk
• meta-analyses of RCTs investigating the effect of vitamin D supplementation on CVD risk, including hypertension and stroke are inconsistent
• many studies in relation to vitamin D use CVD risk as a secondary outcome there are few long term RCTs, supplementing with vitamin D alone
– VITAL (vit D/omega3), n=20,000 healthy participants, 2,000IU vitamin D, 5yrs
• further research to elucidate potential mechanisms is required
• current evidence does not support supplementation of vitamin D to reduce CVD risk
• no basis yet to make recommendations for the optimum supplementation based on anything other than musculoskeletal health (eg. CVD risk)