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  • Review Article
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The effect of vitamin D status on risk factors for cardiovascular disease

Nature Reviews Nephrology volume 9, pages 337–347 (2013)Cite this article

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A Correction to this article was published on 01 October 2013

This article has been updated

Abstract

Vitamin-D-related pathways are implicated in various endocrine, inflammatory and endothelial functions. An estimated 1 billion people in the world have vitamin D deficiency or insufficiency, and undiagnosed vitamin D deficiency is common. Vitamin D deficiency is associated with substantial increases in the incidence of hypertension, hyperlipidaemia, myocardial infarction and stroke, as well as in diseases such as chronic kidney disease and type 2 diabetes. Low vitamin D levels also upregulate the renin–angiotensin–aldosterone system, increase inflammation and cause endothelial dysfunction. However, the role of vitamin D deficiency in cardiovascular morbidity and mortality is an emerging and hotly debated topic. Epidemiological studies suggest an association between low vitamin D levels and risk factors for cardiovascular disease, but a causal relationship has not been established, and clinical trials and meta-analyses have not demonstrated convincing evidence that vitamin D therapy improves cardiovascular outcomes. Some evidence suggests that vitamin D status is a biomarker of lifestyle, since unhealthy and sedentary lifestyles are associated with vitamin D insufficiency or deficiency and are also risk factors for cardiovascular complications.

Key Points

  • Vitamin D deficiency is associated with substantial increases in the incidence of hypertension, hyperlipidaemia, myocardial infarction, stroke, chronic kidney disease and diabetes

  • Low vitamin D levels upregulate the renin–angiotensin–aldosterone system, increase inflammation and cause endothelial dysfunction, among other potentially harmful effects

  • Some evidence suggests that vitamin D status is a biomarker of lifestyle

  • Less healthy and less active lifestyles are associated with vitamin D insufficiency or deficiency and are also risk factors for cardiovascular complications

  • Clinical trials and meta-analyses have not demonstrated a statistically significant benefit of vitamin D therapy on cardiovascular outcomes

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Figure 1: Vitamin-D-related pathways that contribute to cardiovascular morbidity and mortality.
Figure 2: Effect of vitamin D status on cardiovascular disease in children with chronic kidney disease.

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Change history

  • 01 October 2013

    In the originally published article the values in Box 1 were incorrect. The insufficiency range should have been 50–74 nmol/l and the optimal range should have been 75–100 nmol/l. The errors have been corrected for the HTML and PDF versions of the article.

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Acknowledgements

R. I. Thadhani's research is supported by NIH grants K24DK094872-01 and R01DK084974 and a research grant from Abbott Laboratories. R. H. Mak's research is supported by NIH grant U01 DK-3-012 and investigator-initiated grants from the Cystinosis Research Foundation and Abbott Laboratories.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, University of California San Diego, 9500 Gilman Drive, MC 0634, La Jolla, 92093, CA, USA

    Sujana S. Gunta & Robert H. Mak

  2. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 25 Shattuck Street, Boston, 02115, MA, USA

    Ravi I. Thadhani

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  1. Sujana S. Gunta
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S. S. Gunta and R. H. Mak researched data for the article. S. S. Gunta, R. I. Thadhani and R. H. Mak wrote the manuscript and contributed to discussions of the content as well as review and/or editing of the manuscript before submission.

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Correspondence to Robert H. Mak.

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Gunta, S., Thadhani, R. & Mak, R. The effect of vitamin D status on risk factors for cardiovascular disease. Nat Rev Nephrol 9, 337–347 (2013). https://doi.org/10.1038/nrneph.2013.74

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