Can vitamin D deficiency cause cardiovascular disease?

From the Guidelines

Vitamin D deficiency is associated with an increased risk of cardiovascular disease, and maintaining adequate vitamin D levels is crucial for supporting cardiovascular health. The relationship between vitamin D and cardiovascular health is well-established, with observational studies consistently indicating that 25(OH)D levels less than 15 ng/mL are associated with excess risk of cardiovascular events, when compared with levels >30-40 ng/mL 1.

Key Findings

• A nested case-control study in 18,225 men in the Health Professionals Follow-up Study showed that men with a 25(OH)D level ≤ 15 ng/mL had an increased risk for myocardial infarction (MI) relatively to men with a 25(OH)D level ≥ 30 ng/mL (RR 2.42; 95% CI, 1.35-3.84) 1.
• Even men with a 25(OH)D level 22.6-29.9 ng/mL had an increased risk (RR 1.60; 95% CI, 1.10-2.32) compared with those with a 25(OH)D level ≥ 30 ng/mL 1.
• The Ludwigshafen Risk and Cardiovascular health (LURIC) study demonstrated a strong association between vitamin D status and several cardiovascular outcomes, such as cardiovascular mortality, stroke, heart failure, and sudden cardiac death with the lowest risk among those with the highest 25(OH)D level 1.

Recommendations

• Maintaining adequate vitamin D levels through sensible sun exposure, consuming vitamin D-rich foods (fatty fish, fortified dairy, egg yolks), and supplements when necessary can help support cardiovascular health.
• Most adults need 600-800 IU of vitamin D daily, though people with deficiency may require higher supplemental doses (1,000-4,000 IU daily) under medical supervision.
• Individuals at higher risk of deficiency, such as older adults, people with limited sun exposure, or those with darker skin tones, should prioritize vitamin D supplementation and monitoring.

From the Research

Association between Vitamin D Deficiency and Cardiovascular Disease

• Vitamin D deficiency has been associated with an increased risk of cardiovascular diseases, including coronary artery disease, heart failure, and cardiac arrhythmias 2, 3, 4, 5, 6.
• Epidemiological and clinical studies have reported a close association between low vitamin D levels and several cardiovascular risk factors and major cardiovascular diseases 3, 4, 6.
• Vitamin D deficiency seems to predispose to increased morbidity, mortality, and recurrent cardiovascular events 3, 4, 5.

Mechanisms and Risk Factors

• Vitamin D plays a major role in bones and calcium metabolism, and its deficiency has been linked to skeletal and non-skeletal complications 2.
• Low serum 25-hydroxyvitamin D levels are associated with increased risk of cardiovascular diseases, including hypertension, coronary artery disease, ischemic heart disease, heart failure, stroke, and type 2 diabetes 6.
• A serum 25-hydroxyvitamin D level below 50 nmol/l (20 ng/l) is considered deficiency and is linked independently to cardiovascular morbidity and mortality 5.

Controversy and Future Perspectives

• Interventional trials with supplementation of vitamin D in patients at risk of or with established cardiovascular disease are still controversial 3, 4, 6.
• Randomized-controlled trials and Mendelian randomization studies have not succeeded in proving a benefit of vitamin D supplementation, but methodological limitations may affect these findings 6.
• Large, well-powered randomized controlled trials are warranted to determine the effect of vitamin D supplementation on cardiovascular risk factors and hypertension 2.