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补充维生素D对心血管和脑血管结局的影响:一项系统评价和荟萃分析。

Cardiovascular and Cerebrovascular Outcomes With Vitamin D Supplementation: A Systematic Review and Meta-Analysis.

作者信息

Mattumpuram Jishanth, Maniya Muhammad Talha, Faruqui Sabeeh Khawar, Ahmed Aymen, Jaiswal Vikash, Harshakumar Sreedevi Pallath

机构信息

Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.

Department of Medicine, Ziauddin Medical University, Karachi, Pakistan.

出版信息

Curr Probl Cardiol. 2024 Jan;49(1 Pt C):102119. doi: 10.1016/j.cpcardiol.2023.102119. Epub 2023 Oct 5.

Abstract

Vitamin D supplementation has seen a sharp increase in the primary healthcare setting but its efficacy in decreasing the risk of cardiovascular and cerebrovascular events is yet to be reliably established. We aim to determine whether vitamin D supplementation can significantly impact the risk of cardiovascular and cerebrovascular events. An extensive literature search of PubMed, Embase, and Cochrane CENTRAL was conducted from inception till August 2023 to include all the articles comparing vitamin D and placebo. Cardiovascular and cerebrovascular outcomes were presented as risk ratios (RR) with 95% confidence intervals (CIs) and pooled using a random effects model. Thirty-six trials consisting of 493,389 participants were included in our analysis. Our pooled analysis demonstrated no significant difference between vitamin D supplementation and placebo for the risk of cardiovascular mortality (RR 1.01, 95% CI 0.94-1.08; P = 0.80), stroke or cerebrovascular events (RR 1.03, 95% CI 0.95-1.11; P = 0.48), myocardial infarction (MI) (RR 0.98, 95% CI 0.91-1.06; P = 0.65), cerebrovascular mortality (RR 1.00, 95% CI 0.68-1.46; P = 0.99), arrhythmias (RR 0.98, 95% CI 0.66-1.44; P = 0.90) and hemorrhagic or ischemic stroke. There was no significant heterogeneity between the studies in any analysis. There was no significant difference in the risk of cardiovascular and cerebrovascular outcomes with vitamin D supplementation or placebo. Additional large high-powered studies focused on high-risk and vitamin D-deficient populations are required to resolve the current discrepancy in the literature and provide a definitive conclusion to this end.

摘要

在初级医疗保健环境中,维生素D补充剂的使用急剧增加,但其在降低心血管和脑血管事件风险方面的疗效尚未得到可靠证实。我们旨在确定补充维生素D是否能显著影响心血管和脑血管事件的风险。从数据库建立至2023年8月,我们对PubMed、Embase和Cochrane CENTRAL进行了广泛的文献检索,纳入所有比较维生素D和安慰剂的文章。心血管和脑血管结局以风险比(RR)及95%置信区间(CI)呈现,并采用随机效应模型进行汇总。我们的分析纳入了36项试验,共493,389名参与者。我们的汇总分析表明,补充维生素D与安慰剂在心血管死亡率(RR 1.01,95% CI 0.94 - 1.08;P = 0.80)、中风或脑血管事件(RR 1.03,95% CI 0.95 - 1.11;P = 0.48)、心肌梗死(MI)(RR 0.98,95% CI 0.91 - 1.06;P = 0.65)、脑血管死亡率(RR 1.00,95% CI 0.68 - 1.46;P = 0.99)、心律失常(RR 0.98,95% CI 0.66 - 1.44;P = 0.90)以及出血性或缺血性中风方面无显著差异。在任何分析中,各研究之间均无显著异质性。补充维生素D或使用安慰剂在心血管和脑血管结局风险方面无显著差异。需要开展更多针对高危和维生素D缺乏人群的大型、高效力研究,以解决当前文献中的差异,并就此得出明确结论。

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