Vitamin D, Calcium Supplements, and Implications for Cardiovascular Health

Michos, Erin D.; Cainzos‐Achirica, Miguel; Heravi, Amir S.; Appel, Lawrence J.

doi:10.1016/j.jacc.2020.09.617

Cited by 62 publications

(59 citation statements)

References 83 publications

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“…In 2014, the United States Preventive Services Task Force (USPSTF) concluded that among community-dwelling asymptomatic adults aged 18 years and older, there was insufficient evidence (ie, I statement) to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. 1 Over the past 7 years, many randomized clinical trials (RCTs) have evaluated vitamin D supplementation for improving primary or secondary outcomes of cardiovascular disease, cancer, diabetes, depression, bone health, and falls, [2][3][4][5][6][7][8] necessitating a reevaluation of whether screening for vitamin D insufficiency might be worthwhile. The evidence is still not there to inform this decision.…”

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confidence: 99%

“…In epidemiological studies, low blood levels of 25(OH)D have consistently been a factor strongly associated with many health outcomes, such as depression, fractures, frailty, falls, diabetes, hypertension, cardiovascular diseases, cancer, and others. 7 However associations do not equal causation, and low 25(OH)D status might reflect a poorer health status in general owing to reverse causation or confounding by other health or behavioral factors. 7 For example, individuals with obesity, reduced outdoor physical activity, and less healthy diets are more likely to have lower 25(OH)D levels.…”

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confidence: 99%

“…7 However associations do not equal causation, and low 25(OH)D status might reflect a poorer health status in general owing to reverse causation or confounding by other health or behavioral factors. 7 For example, individuals with obesity, reduced outdoor physical activity, and less healthy diets are more likely to have lower 25(OH)D levels. Importantly, high quality RCTs have not found that supplementation with vitamin D meaningfully mitigates these outcomes.…”

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confidence: 99%

“…Importantly, high quality RCTs have not found that supplementation with vitamin D meaningfully mitigates these outcomes. [2][3][4][5][6][7] Even the benefit of vitamin D on bone health and musculoskeletal outcomes has been challenged, 5,12 and its efficacy may depend on whether concomitant calcium supplementation is given. 13 While many of these RCTs did not specifically enroll individuals with a documented deficiency state, post hoc subgroup analyses failed to find outcome benefit for vitamin D supplementation among those with low 25(OH)D levels (ie, <20 ng/mL [to convert to nanomoles per liter, multiply by 2.496]), with less data available for the subgroup of those below 12 ng/ml.…”

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confidence: 99%

“…13 While many of these RCTs did not specifically enroll individuals with a documented deficiency state, post hoc subgroup analyses failed to find outcome benefit for vitamin D supplementation among those with low 25(OH)D levels (ie, <20 ng/mL [to convert to nanomoles per liter, multiply by 2.496]), with less data available for the subgroup of those below 12 ng/ml. 2,3,7 Might the commonly used vitamin D measure be the wrong measure? In the blood, 25(OH)D is the major circulating form and reflects both endogenous and exogenous sources.…”

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confidence: 99%

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Why USPSTF Still Finds Insufficient Evidence to Support Screening for Vitamin D Deficiency

2021

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In 2014, the United States Preventive Services Task Force (USPSTF) concluded that among community-dwelling asymptomatic adults aged 18 years and older, there was insufficient evidence (ie, I statement) to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. 1 Over the past 7 years, many randomized clinical trials (RCTs) have evaluated vitamin D supplementation for improving primary or secondary outcomes of cardiovascular disease, cancer, diabetes, depression, bone health, and falls, 2-8 necessitating a reevaluation of whether screening for vitamin D insufficiency might be worthwhile. The evidence is still not there to inform this decision. 9,10 Screening is the routine evaluation of an asymptomatic population with the goal of detection of a disease, when the natural course of that disease can be altered by early intervention. The benefits of screening in a population need to outweigh any potential harms that might arise from false positive tests, inappropriate downstream testing, and overtreatment of so-called pseudodisease. 11Open Access. This is an open access article distributed under the terms of the CC-BY License.

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confidence: 99%

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confidence: 99%

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Why USPSTF Still Finds Insufficient Evidence to Support Screening for Vitamin D Deficiency

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Fibroblast growth factor 23 independently predicts adverse outcomes after an acute coronary syndrome

Kallmeyer,

Pello,

Cánovas

et al. 2023

ESC Heart Failure

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AimsAbnormalities of mineral metabolism (MM) have been related to cardiovascular disorders. There are no reports on the prognostic role of MM after an acute coronary syndrome (ACS). We aim to assess the prognostic role of MM after an ACS.Methods and resultsPlasma levels of components of MM [fibroblast growth factor 23 (FGF23), calcidiol, parathormone, klotho, and phosphate], high‐sensitivity C‐reactive protein, and N‐terminal‐pro‐brain natriuretic peptide were measured in 1190 patients at discharge from an ACS. The primary outcome was a combination of acute ischaemic events, heart failure (HF) and death. Secondary outcomes were the separate components of the primary outcome. Age was 61.7 ± 12.2 years, and 77.1% were men. Median follow‐up was 5.44 (3.03–7.46) years. Two hundred and ninety‐four patients developed the primary outcome. At multivariable analysis FGF23 (hazard ratio, HR 1.18 [1.08–1.29], P < 0.001), calcidiol (HR 0.86 [0.74–1.00], P = 0.046), previous coronary or cerebrovascular disease, and hypertension were independent predictors of the primary outcome. The predictive power of FGF23 was homogeneous across different subgroups of population. FGF23 (HR 1.45 [1.28–1.65], P < 0.001) and parathormone (HR 1.06 1.01–1.12]; P = 0.032) resulted as independent predictors of HF. FGF23 (HR 1.21 [1.07–1.37], P = 0.002) and calcidiol (HR 0.72 [0.54–0.97), P = 0.028) were independent predictors of death. No biomarker predicted acute ischaemic events. FGF23 predicted independently the primary outcome in patients with estimated glomerular filtration rate > 60 mL/min/1.73 m2.ConclusionsFGF23 and other components of MM are independent predictors of HF and death after an ACS. This effect is homogeneous across different subgroups of population, and it is not limited to patients with chronic kidney disease.

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