Pilz Stefan, Kienreich Katharina, Tomaschitz Andreas, Lerchbaum Elisabeth, Meinitzer Andreas, März Winfried, Zittermann Armin, Dekker Jacqueline M
Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria.
Scand J Clin Lab Invest Suppl. 2012;243:83-91. doi: 10.3109/00365513.2012.681972.
Accumulating evidence suggests that vitamin D may play a role for cardiovascular health. Expression of the vitamin D receptor (VDR) and enzymes for vitamin D metabolism have been identified in the vasculature as well as in the heart. VDR knock-out mice suffer from cardiovascular disease (CVD) and even selective VDR deletion in cardiomyocytes causes myocardial hypertrophy. Many, but not all observational studies showed that vitamin D deficiency is associated with CVD and its risk factors. Low concentrations of 25-hydroxyvitamin D (25(OH)D) are an independent risk factor for cardiovascular events, in particular for strokes and sudden cardiac deaths. Only few randomized controlled trials (RCTs) are available on this topic. These RCTs are frequently limited by the additional supplementation of calcium which may increase the risk of CVD events. RCTs with pure vitamin D supplementation have partially but not consistently shown beneficial effects on cardiovascular risk factors such as arterial hypertension. A number of large RCTs on the impact of vitamin D supplementation on cardiovascular events and mortality have already started but limitations of the study designs such as inclusion of individuals with relatively high 25(OH)D concentrations have to be considered. At present, the evidence is not sufficient for general recommendations to supplement vitamin D in order to prevent and treat CVD. It should, however, be noted that justification for the prevention and treatment of vitamin D deficiency comes from evidence based benefits of vitamin D supplementation on musculoskeletal health.
越来越多的证据表明，维生素D可能对心血管健康发挥作用。在血管以及心脏中已发现维生素D受体（VDR）和维生素D代谢酶的表达。VDR基因敲除小鼠患有心血管疾病（CVD），甚至心肌细胞中VDR的选择性缺失也会导致心肌肥大。许多（但并非全部）观察性研究表明，维生素D缺乏与CVD及其危险因素有关。低浓度的25-羟基维生素D（25(OH)D）是心血管事件的独立危险因素，尤其是中风和心源性猝死。关于这个主题的随机对照试验（RCT）很少。这些RCT常常受到额外补充钙的限制，而额外补充钙可能会增加CVD事件的风险。单纯补充维生素D的RCT对诸如动脉高血压等心血管危险因素部分地（但并非始终一致地）显示出有益效果。一些关于补充维生素D对心血管事件和死亡率影响的大型RCT已经启动，但必须考虑研究设计的局限性，例如纳入25(OH)D浓度相对较高的个体。目前，没有足够的证据支持为预防和治疗CVD而普遍推荐补充维生素D。然而，应该指出的是，预防和治疗维生素D缺乏的依据来自于补充维生素D对肌肉骨骼健康的循证益处。
