Laboratory and Clinic of Experimental Medicine and Endocrinology, University Hospital Leuven, Catholic University of Leuven, Leuven, Belgium.
Curr Opin Lipidol. 2012 Feb;23(1):17-23. doi: 10.1097/MOL.0b013e32834d7357.
To offer a comprehensive overview of the best available evidence linking vitamin D status, including the effect of vitamin D supplementation, to the risk of cardiovascular events.
There is an abundance of plausible mechanisms by which vitamin D might have a favorable effect on the cardiovascular risk profile in the general population. Epidemiological data strongly support such beneficial effects of vitamin D, but initial enthusiasm is giving way to skepticism as larger, well conducted, longitudinal observational trials fail to show an association between serum vitamin D levels and mortality from cardiovascular events. Moreover, the few existing prospective randomized controlled trials with vitamin D supplementation that report the incidence of cardiovascular events show no effect. Fortunately, larger and better designed prospective trials are underway. Nonetheless, one should also acknowledge that true vitamin D deficiency [<25 nmol/l (10 ng/ml)] remains prevalent in the general population and is convincingly associated with overall adverse outcomes.
Currently, robust clinical data are lacking to support raising intake requirements and target vitamin D plasma levels based on a role for vitamin D in preventing cardiometabolic diseases. Nonetheless, the high prevalence of vitamin D deficiency in the general population remains alarming and requires implementation of clear supplementation guidelines.
提供有关维生素 D 状态(包括维生素 D 补充的效果)与心血管事件风险之间关联的最佳现有证据的全面概述。
有大量合理的机制表明维生素 D 可能对普通人群的心血管风险状况产生有利影响。流行病学数据强烈支持维生素 D 的这种有益作用,但随着更大规模、精心设计的纵向观察性试验未能显示血清维生素 D 水平与心血管事件死亡率之间存在关联,最初的热情正在转变为怀疑。此外,少数现有的维生素 D 补充前瞻性随机对照试验报告心血管事件的发生率没有影响。幸运的是,更大规模和设计更好的前瞻性试验正在进行中。尽管如此,人们也应该认识到,真正的维生素 D 缺乏症(<25nmol/L(10ng/ml))在普通人群中仍然很普遍,并与整体不良结局有明确的关联。
目前,缺乏强有力的临床数据来支持根据维生素 D 在预防心血管代谢疾病中的作用来提高摄入需求和目标维生素 D 血浆水平。尽管如此,普通人群中维生素 D 缺乏症的高发率仍然令人震惊,需要制定明确的补充指南。