Coronary heart diseasePrevention

It is very likely that vitamin D can reduce the risk of coronary heart disease (CHD)1.

There are significant correlations between CHD and diabetes2 and the metabolic syndrome3. Vitamin D reduces the risk of developing the metabolic syndrome4.

Higher vitamin D plus calcium intake was associated with reduced risk of type 2 diabetes in an observational study5. However, additional randomized controlled studies with sufficient vitamin D and calcium are required to determine the dose-response and benefit relations67. There is a significantly increased risk of hypertension with lower serum 25(OH)D levels8

Based on the general findings for vitamin D and related incidence and mortality rates for CVD9 and some findings for CHD discussed in this document, it appears that keeping serum 25(OH)D levels > 30–40 ng/mL (>75–100 nmol/L) can reduce the risk of CHD. 

Several studies investigating the role of calcium supplementation and the risk of CHD reported a 30% increased risk (uncertainty nearly 30%) of CHD for those taking >500 mg/day of calcium compared to a placebo10.

A study of women in Finland found a hazard ratio for CHD of 1.24 (95% CI, 1.02–1.52) in women who used calcium or calcium plus vitamin D supplements11.

However, the Women’s Health Initiative study in the United States, in which women took 1500 mg/day of calcium with or without 400 IU/day of vitamin D3, found little effect12.

There were a number of letters to the editor of the British Medical Journal, responding to the study by Bolland10. The most important comment seemed to be that when sufficient vitamin D is taken along with calcium supplements, there should not be an increased risk of CHD from taking calcium supplements. 

In a related meta-analysis of CVD (CHD, stroke, etc.) mortality rate with respect to vitamin D and calcium intake, little effect was found for calcium with vitamin D:

Five prospective studies of patients receiving dialysis and one study involving a general population showed consistent reductions in cardiovascular disease (CVD) mortality among adults who received vitamin D supplements. Four prospective studies of initially healthy persons found no differences in incidence of CVD between calcium supplement recipients and nonrecipients. Results of secondary analyses in 8 randomized trials showed a slight but statistically nonsignificant reduction in CVD risk (pooled relative risk, 0.90 [95% CI, 0.77 to 1.05]) with vitamin D supplementation at moderate to high doses (approximately 1000 IU/d) but not with calcium supplementation (pooled relative risk, 1.14 [CI, 0.92 to 1.41]), or a combination of vitamin D and calcium supplementation (pooled relative risk, 1.04 [CI, 0.92 to 1.18]) compared with placebo13

Page last edited: 09 May 2011

References

  1. Anagnostis, P. Athyros, V. G. Adamidou, F. Florentin, M. Karagiannis, A. Vitamin D and cardiovascular disease: a novel agent for reducing cardiovascular risk?. Curr Vasc Pharmacol. 2010 Sep; 8 (5): 720-30.
  2. Gholap, N. Davies, M. Patel, K. Sattar, N. Khunti, K. Type 2 diabetes and cardiovascular disease in South Asians. Prim Care Diabetes. 2010 Sep 23;
  3. Mottillo, S. Filion, K. B. Genest, J. Joseph, L. Pilote, L. Poirier, P. Rinfret, S. Schiffrin, E. L. Eisenberg, M. J. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010 Sep 28; 56 (14): 1113-32.
  4. Boucher, B. J. Inadequate vitamin D status: does it contribute to the disorders comprising syndrome ‘X’?. Br J Nutr. 1998 Apr; 79 (4): 315-27.
  5. Pittas, A. G. Dawson-Hughes, B. Li, T. Van Dam, R. M. Willett, W. C. Manson, J. E. Hu, F. B. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care. 2006 Mar; 29 (3): 650-6.
  6. Boucher, B. J. Vitamin D insufficiency and Diabetes Risks. Curr Drug Targets. 2010 Aug 27;
  7. Pittas, A. G. Chung, M. Trikalinos, T. Mitri, J. Brendel, M. Patel, K. Lichtenstein, A. H. Lau, J. Balk, E. M. Systematic review: Vitamin D and cardiometabolic outcomes. Ann Intern Med. 2010 Mar 2; 152 (5): 307-14.
  8. Forman, J. P. Giovannucci, E. Holmes, M. D. Bischoff-Ferrari, H. A. Tworoger, S. S. Willett, W. C. Curhan, G. C. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension. 2007 May; 49 (5): 1063-9.
  9. Parker, J. Hashmi, O. Dutton, D. Mavrodaris, A. Stranges, S. Kandala, N. B. Clarke, A. Franco, O. H. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas. 2010 Mar; 65 (3): 225-36.
  10. Bolland, M. J. Avenell, A. Baron, J. A. Grey, A. MacLennan, G. S. Gamble, G. D. Reid, I. R. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010; 341c3691.
  11. Pentti, K. Tuppurainen, M. T. Honkanen, R. Sandini, L. Kroger, H. Alhava, E. Saarikoski, S. Use of calcium supplements and the risk of coronary heart disease in 52-62-year-old women: The Kuopio Osteoporosis Risk Factor and Prevention Study. Maturitas. 2009 May 20; 63 (1): 73-8.
  12. Manson, J. E. Allison, M. A. Carr, J. J. Langer, R. D. Cochrane, B. B. Hendrix, S. L. Hsia, J. Hunt, J. R. Lewis, C. E. Margolis, K. L. Robinson, J. G. Rodabough, R. J. Thomas, A. M. Calcium/vitamin D supplementation and coronary artery calcification in the Women’s Health Initiative. Menopause. 2010 Jul; 17 (4): 683-91.
  13. Wang, L. Manson, J. E. Song, Y. Sesso, H. D. Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med. 2010 Mar 2; 152 (5): 315-23.