A therosclerosis, the principal cause of cardiovascular diseases (CVDs), is a process that involves a complex interplay among different factors and cell types, including cells of the immune system (T cells, B cells, natural killer cells, monocytes/macrophages, dendritic cells) and cells of the vessel wall (endothelial cells [ECs], vascular smooth muscle cells [VSMCs]). The atherogenic process evolves in different stages, starting from inflammatory endothelial activation/ dysfunction and resulting in plaque vulnerability and rupture. Vitamin D deficiency affects almost 50% of the population worldwide. It has been suggested that this pandemic might contribute to the worldwide increased prevalence of CVD.
9-11Several mechanisms have been proposed to account for this inverse relationship. In addition to its effects exerted on numerous tissues and organs that indirectly participate in the atherosclerosis, vitamin D is directly involved in this systemic inflammatory process.12,13 Vitamin D receptors (VDRs) are present in all cells implicated in atherosclerosis, including ECs, VSMCs, and immune cells. Vitamin D appears to regulate a wide range of physiological and pathological processes like vascular cell growth, migration, and differentiation; immune response modulation; cytokine expression; and inflammatory and fibrotic pathways, all of which play a crucial role, starting from the early stage of endothelial activation/dysfunction to the later stages of the plaque vulnerability and rupture.In this review, we provide current data on the effects of vitamin D on cells directly implicated in atherosclerosis such as ECs, VSMCs, and immune cells (lymphocytes, monocytes, macrophages, etc) with a focus on the underlying molecular mechanisms, which are still largely unknown. We also summarize reports related to the favorable (antiatherogenic) actions of vitamin D in tissues and organs that indirectly participate in the atherogenic process. Finally, we critically discuss clinical studies to assess the protective role of vitamin D and the efficacy of vitamin D and VDR agonists in CVD. Because a comprehensive background is a prerequisite for further discussions of vitamin D-induced effects, we provide a brief description of vitamin D metabolism and mechanism of action.
Vitamin D Metabolism and Mechanism of ActionVitamin D is a steroid hormone that comes in 2 forms that differ chemically in their side chain, D 2 and D 3 (Figure 1). Either produced in the skin (D 3 ) from 7-dehydrocholesterol by exposure to ultraviolet-B light or ingested with foods of plant or animal origin (D 2 and D 3 , respectively), vitamin D is biologically inert and requires 2 hydroxylations to form its active metabolite. 10 The first hydroxylation is constitutive and takes place in the liver by vitamin D-25-hydroxylase to form 25(OH)D. The second hydroxylation is catalyzed by 25(OH) D-1aOHase (CYP27B1) to form the biologically active form of vitamin D, 1,25(OH) 2 D (calcitriol; see Figure 1). This latter 1a-hydroxylation of 25(OH)D takes place in most tiss...