Kim Samuel M, Lutsey Pamela L, Michos Erin D
Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
Curr Cardiovasc Risk Rep. 2017 Jan;11(1). doi: 10.1007/s12170-017-0528-7. Epub 2017 Jan 21.
To provide a state-of-the-art update on some emerging measures of vitamin D status and discuss how assessment of these key vitamin D metabolites might improve prognostication of risk for cardiovascular disease (CVD) outcomes.
Vitamin D deficiency is a highly prevalent condition and relatively easy to treat with supplementation and/or modest sunlight exposure. A substantial body of experimental and epidemiological evidence suggest that vitamin D deficiency is a risk factor for CVD. Most epidemiologic studies to date have focused on total 25-hydroxyvitamin D [25(OH)D] concentrations, which is the established marker of vitamin D stores. However, there is emerging evidence that other novel markers of vitamin D metabolism may better characterize 'true' vitamin D status. Some key novel measures include bioavailable 25(OH)D, free 25(OH)D, 1-25 dihydroxyvitamin D, 24,25-dihydroxyvitamin D3 [24,25(OH)D3], and ratio of 24,25(OH)D3 to 25(OH)D [the vitamin D metabolic ratio]. Utilization of these biomarkers may enhance understanding of the association between vitamin D and CVD risk, and may provide explanation for the observation that 25(OH)D is a stronger CVD risk factor in whites than blacks.
Novel measures of vitamin D status could potentially change clinical practice regarding how patients are currently screened for vitamin D status and defined as vitamin D deficient or not. However, whether measuring any of these alternate markers of vitamin D status can provide further insight regarding CVD risk beyond the traditionally measured 25(OH)D concentrations is uncertain at this time. This is an area where further research is strongly needed.
提供关于维生素D状态一些新出现测量方法的最新进展，并讨论对这些关键维生素D代谢产物的评估如何改善心血管疾病（CVD）结局风险的预测。
维生素D缺乏是一种高度普遍的情况，通过补充和/或适度晒太阳相对容易治疗。大量实验和流行病学证据表明，维生素D缺乏是CVD的一个危险因素。迄今为止，大多数流行病学研究都集中在总25-羟基维生素D[25(OH)D]浓度上，这是维生素D储备的既定标志物。然而，有新出现的证据表明，其他维生素D代谢的新标志物可能更好地表征“真正的”维生素D状态。一些关键的新测量方法包括生物可利用的25(OH)D、游离25(OH)D、1,25-二羟基维生素D、24,25-二羟基维生素D3[24,25(OH)D3]以及24,25(OH)D3与25(OH)D的比值[维生素D代谢比值]。使用这些生物标志物可能会增强对维生素D与CVD风险之间关联的理解，并可能解释25(OH)D在白人中比在黑人中是更强的CVD危险因素这一观察结果。
维生素D状态的新测量方法可能会潜在地改变目前对患者进行维生素D状态筛查以及定义是否维生素D缺乏的临床实践。然而，目前尚不确定测量这些维生素D状态的替代标志物中的任何一种是否能提供超出传统测量的25(OH)D浓度之外关于CVD风险的进一步见解。这是一个急需进一步研究的领域。
