Zittermann Armin
Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
Anticancer Res. 2018 Feb;38(2):1179-1186. doi: 10.21873/anticanres.12338.
This review was conducted to assess the dose-response relationship between vitamin D and cardiovascular disease (CVD) outcomes in humans: Prospective cohort studies indicate a multivariable-adjusted non-linear increase in CVD events at levels of circulating 25-hydroxyvitamin D [25(OH)D] of less than 50 nmol/l. However, Mendelian randomization studies do not support these findings. Although meta-analyses of randomized controlled trials (RCTs) do not rule out small beneficial vitamin D effects on surrogate parameters of CVD risk, such as arterial stiffness, at vitamin D doses equivalent to 1,000-5,333 IU daily, other meta-analyses of RCTs show no reduction in CVD events by vitamin D supplementation. Notably, some cohort studies and a recent RCT provide evidence for harmful effects of vitamin D on CVD outcomes at 25(OH)D levels in excess of 100 nmol/l. In conclusion, more studies in individuals with a deficient 25(OH)D level (i.e. <30 nmol/l) are needed, but caution is necessary regarding supplementation with vitamin D doses achieving a 25(OH)D level which exceeds 100 nmol/l.
本综述旨在评估人体中维生素D与心血管疾病（CVD）结局之间的剂量反应关系：前瞻性队列研究表明，循环25-羟基维生素D[25(OH)D]水平低于50 nmol/l时，CVD事件经多变量调整后呈非线性增加。然而，孟德尔随机化研究并不支持这些发现。虽然对随机对照试验（RCT）的荟萃分析不排除维生素D对CVD风险替代参数（如动脉僵硬度）有小的有益作用，在相当于每日1000 - 5333 IU的维生素D剂量下，但其他RCT的荟萃分析显示补充维生素D并不能减少CVD事件。值得注意的是，一些队列研究和最近的一项RCT提供了证据，表明25(OH)D水平超过100 nmol/l时，维生素D对CVD结局有有害影响。总之，需要对25(OH)D水平不足（即<30 nmol/l）的个体进行更多研究，但对于补充维生素D使25(OH)D水平超过100 nmol/l时需谨慎。
