Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-01-08T08:48:54.523Z Has data issue: false hasContentIssue false
  • English
  • Français

Putting cardiovascular disease and vitamin D insufficiency into perspective

Published online by Cambridge University Press:  08 March 2007

Armin Zittermann ,
Stefanie S. Schleithoff  and
Reiner Koerfer
Armin Zittermann*
Affiliation:
Department of Cardio-Thoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
Stefanie S. Schleithoff
Affiliation:
Department of Cardio-Thoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
Reiner Koerfer
Affiliation:
Department of Cardio-Thoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
*
*Corresponding author: Dr Armin Zittermann, fax +49 5731 97 2020, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The aetiology of CVD is still not completely understood. The present review article summarises data supporting the hypothesis that an insufficient vitamin D status may contribute to the worldwide high prevalence of CVD. Human vitamin D status primarily depends on skin exposure to the UVB spectrum of the sunlight. Epidemiological data indicate that geographic latitude, altitude, season, and the place of residence (urban or rural) are associated with CVD mortality. Interestingly, all these factors also have an influence on human UVB exposure and thus on vitamin D status. Several mechanisms might be responsible for a protective role of vitamin D in CVD. These mechanisms include the inhibition of vascular smooth muscle proliferation, the suppression of vascular calcification, the down regulation of pro-inflammatory cytokines, the up regulation of anti-inflammatory cytokines, and the action of vitamin D as a negative endocrine regulator of the renin–angiotensin system. The first intervention trials indicate that vitamin D may suppress cardiovascular risk markers. However, more controlled clinical trials are needed to investigate whether optimal oral vitamin D supplementation is able to reduce CVD morbidity and mortality.

Keywords

Cardiovascular diseaseVitamin DParathyroid hormoneInflammationCytokines
Type
Review article
Information
British Journal of Nutrition , Volume 94 , Issue 4 , October 2005 , pp. 483 - 492
Copyright
Copyright © The Nutrition Society 2005

References

Agarwal, KS, Mughal, MZ, Upadhyay, P, Berry, JL, Mawer, EB & Puliyel, JM (2002) The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child 87, 111–113.CrossRefGoogle ScholarPubMed
Ahlawat, SK, Singh, MM, Kumar, R, Kumari, S & Sharma, BK (2002) Time trends in the prevalence of hypertension and associated risk factors in Chandigarh. J Indian Med Assoc 100, 547–554.Google ScholarPubMed
Akinkugbe, OO (1990) Epidemiology of cardiovascular disease in developing countries. J Hypertens 8, S233–S238.Google ScholarPubMed
Anonymous (1992) An epidemiological study of cardiovascular and cardiopulmonary disease risk factors in four populations in the People's Republic of China. Baseline report from the P.R.C.-U.S.A. Collaborative Study. People's Republic of China–United States Cardiovascular and Cardiopulmonary Epidemiology Research Group. Circulation 85, 1083–1096.CrossRefGoogle Scholar
Anonymous (2004) The catastrophic failures of public health. Lancet 363, 745.CrossRefGoogle Scholar
Arunabh, S, Pollack, S, Yeh, J & Aloia, JF (2003) Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab 88, 157–161.CrossRefGoogle ScholarPubMed
Atkinson, J, Poitevin, P, Chillon, JM, Lartaud, I & Levy, B (1994) Vascular Ca overload produced by vitamin D3 plus nicotine diminishes arterial distensibility in rats. Am J Physiol 266, H540–H547.Google ScholarPubMed
Baedenkopf, WG, Daoud, AS & Love, BM (1964) Calcification in the coronary arteries and its relationship to artheriosclerosis and myocardial infarction. Am J Roentgenol 92, 865–871.Google Scholar
Banks, LM, Lees, B, MacSweeney, JE & Stevenson, JC (1994) Effect of degenerative spinal and aortic calcification on bone density measurements in post-menopausal women: links between osteoporosis and cardiovascular disease? Eur J Clin Invest 24, 813–817.CrossRefGoogle Scholar
Barengolts, EI, Berman, M, Kukreja, SC, Kouznetsova, T, Lin, C & Chomka, EV (1998) Osteoporosis and coronary atherosclerosis in asymptomatic postmenopausal women. Calcif Tissue Int 62, 209–213.CrossRefGoogle ScholarPubMed
Bhattoa, HP, Bettenbut, P, Ganacharya, S, & Balogh, (2004) Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in community dwelling postmenopausal Hungarian women. Osteoporos Int 15, 447–451.CrossRefGoogle ScholarPubMed
Block, GA, Hulbert-Shearon, TE, Levin, NW & Port, FK (1998) Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 31, 607–617.CrossRefGoogle ScholarPubMed
Block, GA, Martin, KJ, de Francisco, AL et al. , (2004) Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med 350, 1516–1525.CrossRefGoogle ScholarPubMed
Boucher, BJ (1998) Inadequate vitamin D status: does it contribute to the disorders comprising syndrome X? Br J Nutr 79, 315–327.CrossRefGoogle Scholar
Bouillon, RA, Auwerx, JH, Lissens, WD & Pelemanns, WK (1987) Vitamin D status in the elderly: seasonal substrate deficiency causes 1,25-dihydroxycholecalciferol deficiency. Am J Clin Nutr 45, 755–763.CrossRefGoogle ScholarPubMed
Canning, MO, Grotenhuis, K, de Wit, H, Ruwhof, C & Drexhage, HA (2001) 1-alpha,25-Dihydroxyvitamin D3 (1,25(OH)(2)D(3)) hampers the maturation of fully active immature dendritic cells from monocytes. Eur J Endocrinol 145, 351–357.CrossRefGoogle Scholar
Chapuy, MC, Schott, AM, Garnero, P, Hans, D, Delmas, PD & Meunier, PJ (1996) Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. EPIDOS Study Group. J Clin Endocrinol Metab 81, 1129–1133.Google ScholarPubMed
Chiu, KC, Chu, A, Go, VL & Saad, MF (2004) Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 79, 820–825.CrossRefGoogle ScholarPubMed
Crawford, VL, Sweeney, O, Coyle, PV, Halliday, IM & Stout, RW (2000) The relationship between elevated fibrinogen and markers of infection: a comparison of seasonal cycles. QJM 93, 745–750.CrossRefGoogle ScholarPubMed
Davies, MR & Hruska, KA (2001) Pathophysiological mechanisms of vascular calcification in end-stage renal disease. Kidney Int 60, 472–479.CrossRefGoogle ScholarPubMed
Davies, PS, Bates, CJ, Cole, TJ, Prentice, A & Clarke, PC (1999) Vitamin D: seasonal and regional differences in preschool children in Great Britain. Eur J Clin Nutr 53, 195–198.CrossRefGoogle ScholarPubMed
Dent, CE, Engelbrecht, HE & Godfrey, RC (1968) Osteoporosis of lumbar vertebrae and calcification of abdominal aorta in women living in Durban. Br Med J 4, 76–79.CrossRefGoogle ScholarPubMed
Docio, S, Riancho, JA, Perez, A, Olmos, JM, Amado, JA & Gonzalez-Macias, J (1998) Seasonal deficiency of vitamin D in children: a potential target for osteoporosis-preventing strategies? J Bone Miner Res 13, 544–548.CrossRefGoogle ScholarPubMed
Doherty, TM & Detrano, RC (1994) Coronary arterial calcification as an active process: a new perspective on an old problem. Calcif Tissue Int 54, 224–230.CrossRefGoogle Scholar
Douglas, AS, Allan, TM & Rawles, JM (1991) Composition of seasonality of disease. Scott Med J 36, 76–82.CrossRefGoogle ScholarPubMed
Douglas, AS, Dunnigan, MG, Allan, TM & Rawles, JM (1995) Seasonal variation in coronary heart disease in Scotland. J Epidemiol Commun Health 49, 575–582.CrossRefGoogle ScholarPubMed
Elford, J, Phillips, AN, Thomson, AG & Shaper, AG (1989) Migration and geographic variations in ischaemic heart disease in Great Britain. Lancet i, 343–346.CrossRefGoogle Scholar
Enquselassie, F, Dobson, AJ, Alexander, HM & Steele, PL (1993) Seasons, temperature and coronary disease. Int J Epidemiol 22, 632–636.CrossRefGoogle ScholarPubMed
Enterline, PE, Rikli, AE & Sauer, HI (1960) Death rates for coronary heart disease in metropolitan and other areas. Pub Health Rep 75, 759–766.CrossRefGoogle ScholarPubMed
Evans, AE, Ruidavets, JB, McCrum, E et al. , (1995) Autre pays, autres coeurs? Dietary patterns, risk factors and ischaemic heart disease in Belfast and Toulouse (WHO MONICA project). QJM 88, 469–477.Google Scholar
Federal Statistical Office (2003) Statistical Yearbook 2003 for Foreign Countries. Wiesbaden, Germany: Federal Statistical Office.Google Scholar
Fleck, A (1989) Latitude and ischemic heart disease. Lancet i, 613.CrossRefGoogle Scholar
Fraser, JD, Otawara, Y & Price, PA (1988) 1,25-Dihydroxyvitamin D3 stimulates the synthesis of matrix gamma-carboxyglutamic acid protein by osteosarcoma cells. Mutually exclusive expression of vitamin K-dependent bone proteins by clonal osteoblastic cell lines. J Biol Chem 263, 911–916.CrossRefGoogle ScholarPubMed
Frohlich, M, Sund, M, Russ, S, Hoffmeister, A, Fischer, HG, Hombach, V & Koenig, W (1997) Seasonal variations of rheological and hemostatic parameters and acute-phase reactants in young, healthy subjects. Arterioscler Thromb Vasc Biol 17, 2692–2697.CrossRefGoogle ScholarPubMed
Fujita, T, Okamoto, Y, Sakagami, Y, Ota, K & Ohata, M (1984) Bone changes and aortic calcification in aging inhabitants of mountain versus seacoast communities in the Kii Peninsula. J Am Geriatr Soc 32, 124–128.CrossRefGoogle ScholarPubMed
Fukagawa, M & Kurokawa, K (2005) Renal failure and secondary hyperparathyreodism. In Vitamin D, 2nd ed. pp. 1821–1831 [Feldman, D, Pike, JW and Glorieux, FH, editors]. Amsterdam: The Netherlands: Elsevier Academic Press.CrossRefGoogle Scholar
Gannage-Yared, MH, Chemali, R, Yaacoub, N & Halaby, G (2000) Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res 15, 1856–1862.CrossRefGoogle Scholar
Gjonca, A & Bobak, M (1997) Albanian paradox, another example of protective effect of Mediterranean lifestyle? Lancet 350, 1815–1817.CrossRefGoogle ScholarPubMed
Glerup, H, Mikkelsen, K, Poulsen, L, Hass, E, Overbeck, S, Thomsen, J, Charles, P & Eriksen, EF (2000) Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med 247, 260–268.CrossRefGoogle Scholar
Global Cardiovascular Infobase (2003) WHO Collaborating Centre for Surveillance of Cardiovascular Diseases. www.cvinfobase.a (Accessed 23 September 2003).Google Scholar
Gomez-Alonso, C, Naves-Diaz, MLFeernandez-Martin, JL, Diaz-Lopez, JB, Fernandez-Coto, MT & Cannata-Andia, JB (2003) Vitamin D status and secondary hyperparathyroidism: the importance of 25-hydroxyvitamin D cut-off levels. Kidney Int 85, 44–48.CrossRefGoogle Scholar
Gordan, RS & Danner, RN (1977) Coronary heart disease at high altitudes. N Engl J Med 297, 60–62.Google Scholar
Goswami, R, Gupta, N, Goswami, D, Marwaha, R, Tandon, N & Kochupillai, N (2000) Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr 72, 472–475.CrossRefGoogle ScholarPubMed
Grant, WB (2003) Ecologic studies of solar UV-B radiation and cancer mortality rates. Recent Results Cancer Res 164, 371–377.CrossRefGoogle ScholarPubMed
Grimes, DS, Hindle, E & Dyer, T (1996) Sunlight, cholesterol and coronary heart disease. QJM 89, 579–589.CrossRefGoogle ScholarPubMed
Grimes, DS, Hindle, E & Dyer, T (2000) Respiratory infection and coronary heart disease: progression of a paradigm. QJM 93, 375–383.CrossRefGoogle ScholarPubMed
Guillemant, J, Le, HT, Maria, A, Allemandou, A, Peres, G & Guillemant, S (2001) Wintertime vitamin D deficiency in male adolescents: effect on parathyroid function and response to vitamin D3 supplements. Osteoporos Int 12, 875–879.CrossRefGoogle ScholarPubMed
Gupta, R (1996) Lifestyle risk factors and coronary heart disease prevalence in Indian men. J Assoc Physicians India 44, 689–693.Google ScholarPubMed
Gupta, R, Prakash, H & Kaul, V (1997) Cholesterol lipoproteins, triglycerides, rural-urban differences and prevalence of dyslipidaemia among males in Rajasthan. J Assoc Physicians India 45, 275–279.Google ScholarPubMed
Halloran, BP, Schaefer, P, Lifschitz, M, Levens, M & Goldsmith, RS (1984) Plasma vitamin D metabolite concentrations in chronic renal failure: effect of oral administration of 25-hydroxyvitamin D3. J Clin Endocrinol Metab 59, 1063–1069.CrossRefGoogle Scholar
Hass, GM, Truehart, RE, Taylor, CB & Stumpe, M (1958) An experimental histologic study of hypervitaminosis D. Am J Pathol 34, 395–431.Google ScholarPubMed
Heaney, RP, Davies, KM, Chen, TC, Holick, MF & Barger-Lux, MJ (2003) Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77, 204–210.CrossRefGoogle ScholarPubMed
Hegarty, V, Woodhouse, P & Khaw, KT (1994) Seasonal variation in 25-hydroxyvitamin D and parathyroid hormone concentrations in healthy elderly people. Age Ageing 23, 478–482.CrossRefGoogle ScholarPubMed
Heinrich, PC, Castell, JV & Andus, T (1990) Interleukin-6 and the acute phase response. Biochem J 265, 621–636.CrossRefGoogle ScholarPubMed
Holick, M (1995) Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 61, Suppl., 638S–645S.CrossRefGoogle ScholarPubMed
Holick, MF (2002) Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 9, 87–98.CrossRefGoogle Scholar
Hollenberg, NK, Martinez, G, McCullough, M, Meinking, T, Passan, D, Preston, M, Rivera, A, Taplin, D & Vicaria-Clement, M (1997) Aging, acculturation, salt intake, and hypertension in the Kuna of Panama. Hypertension 29, 171–176.CrossRefGoogle ScholarPubMed
Honye, J, Mahon, DJ, Jain, A, White, CJ, Ramee, SR, Wallis, JB, Al-Zarka, A & Tobis, JM (1992) Morphological effects of coronary balloon angioplasty in vivo assessed by intravascular ultrasound imaging. Circulation 85, 1012–1025.CrossRefGoogle ScholarPubMed
Hultgren, HN (1970) Reduction of systemic arterial blood pressure at high altitude. Adv Cardiol 5, 49–55.CrossRefGoogle Scholar
Ishimura, E, Nishizawa, Y, Inaba, M et al. , (1999) Serum levels of 1,25-dihydroxyvitamin D, 24,25-dihydroxyvitamin D, and 25-hydroxyvitamin D in nondialyzed patients with chronic renal failure. Kidney Int 55, 1019–27.CrossRefGoogle Scholar
Juttmann, JR, Buurman, CJ, DeKam, E, Visser, TJ & Birkenhager, JC (1981) Serum concentrations of metabolites of vitamin D in patients with chronic renal failure. Clin Endocrinol 14, 225–236.CrossRefGoogle ScholarPubMed
Kamycheva, E, Sundsfjord, J & Jorde, R (2004) Serum parathyroid hormone levels predict coronary heart disease: the Tromso Study. Eur J Cardiovasc Prev Rehabil 11, 69–74.CrossRefGoogle ScholarPubMed
Kent, SP, Vawter, GF, Dowben, RM & Benson, RE (1958) Hypervitaminosis D in monkeys: a clinical and pathological study. Am J Pathol 34, 37–59.Google Scholar
Kimura, Y, Kawamura, M, Owada, M, Oshima, T, Murooka, M, Fujiwara, T & Hiramori, K (1999) Effectiveness of 1,25-dihydroxyvitamin D supplementation on blood pressure reduction in a pseudohypoparathyroidism patient with high renin activity. Intern Med 38, 31–35.CrossRefGoogle Scholar
Krause, R, Buhring, M, Hopfenmuller, W, Holick, MF & Sharma, AM (1998) Ultraviolet B and blood pressure. Lancet 352, 709–710.CrossRefGoogle ScholarPubMed
Lamberg-Allardt, CJ, Outila, TA, Karkkainen, MU, Rita, HJ & Valsta, LM (2001) Vitamin D deficiency and bone health in healthy adults in Finland: could this be a concern in other parts of Europe? J Bone Miner Res 16, 2066–2073.CrossRefGoogle ScholarPubMed
Lehtonen-Veromaa, M, Mottonen, T, Irjala, K, Karkkainen, M, Lamberg-Allardt, C, Hakola, P & Viikari, J (1999) Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year-old Finnish girls. Eur J Clin Nutr 53, 746–751.CrossRefGoogle ScholarPubMed
Li, YC, Kong, J, Wei, M, Chen, ZF, Liu, SQ & Cao, LP (2002) 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 110, 229–238.CrossRefGoogle Scholar
Lind, L, Hanni, A, Lithell, H, Hvarfner, A, Sorensen, OH & Ljunghall, S (1995) Vitamin D is related to blood pressure and other cardiovascular risk factors in middle-aged. Am J Hypertens 8, 894–901.CrossRefGoogle ScholarPubMed
Linhares, ER, Jones, DA, Round, JM & Edwards, RH (1984) Effect of nutrition on vitamin D status: studies on healthy and poorly nourished Brazilian children. Am J Clin Nutr 39, 625–630.CrossRefGoogle ScholarPubMed
Lips, P (2005) How to define normal values for serum concentrations of 25-hydroxyvitamin D? In Vitamin D 2nd ed. pp. 1019–1028 [Feldman, D, Pike, JW and Glorieux, FH, editors]. Amsterdam, The Netherlands: Elsevier Academic Press.CrossRefGoogle Scholar
Lips, P, Graafmanns, WC, Ooms, ME, Bezemer, PD & Bouter, LM (1996) Vitamin D supplementation and fracture incidence in elderly persons. A randomised, placebo-controlled clinical trial. Ann Int Med 15, 400–406.CrossRefGoogle Scholar
Looker, AC, Dawson-Hughes, B, Calvo, MS, Gunter, EW & Sahyoun, NR (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30, 771–777.CrossRefGoogle ScholarPubMed
Luo, G, Ducy, P, McKee, MD, Pinero, GJ, Loyer, E, Behringer, RR & Karsenty, G (1997) Spontaneous calcification of arteries and cartilage in mice lacking matrix GLA protein. Nature 386, 78–81.CrossRefGoogle ScholarPubMed
McKenna, M (1992) Differences in vitamin D status between countries in young adults and elderly. Am J Med 93, 69–77.CrossRefGoogle Scholar
Mallat, Z, Besnard, S, Duriez, M et al. , (1999) Protective role of interleukin-10 in atherosclerosis. Circulation Res 85, E17–E24.CrossRefGoogle ScholarPubMed
Margolis, JR, Chen, JT, Kong, Y, Peter, RH, Behar, VS & Kisslo, JA (1980) The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases. Radiology 137, 609–616.CrossRefGoogle ScholarPubMed
Mavri, A, Guzic-Salobir, B, Salobir-Pajnic, B, Keber, I, Stare, J & Stegnar, M (2001) Seasonal variation of some metabolic and haemostatic risk factors in subjects with and without coronary artery disease. Blood Coagul Fibrinolysis 12, 359–365.CrossRefGoogle ScholarPubMed
Meier, C, Woitge, HW, Witte, K, Lemmer, B & Seibel, MJ (2004) Supplementation with oral vitamin D3 and calcium during winter prevents seasonal bone loss: a randomized controlled open-label prospective trial. J Bone Miner Res 19, 1221–1230.CrossRefGoogle ScholarPubMed
Mendall, MA, Patel, P, Asante, M, Ballam, L, Morris, J, Strachan, DP, Camm, AJ & Northfield, TC (1997) Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Heart 78, 273–277.CrossRefGoogle ScholarPubMed
Mims, FM (1996) Significant reduction of UVB caused by smoke from biomass burning in Brazil. Photochem Photobiol 64, 814–816.Google ScholarPubMed
Mitnick, MA, Grey, A, Masiukiewicz, U, Bartkiewicz, M, Rios-Velez, L, Friedman, S, Xu, L, Horowitz, MC & Insogna, K (2001) Parathyroid hormone induces hepatic production of bioactive interleukin-6 and its soluble receptor. Am J Physiol 280, E405–E412.Google ScholarPubMed
Moon, J, Bandy, B & Davison, AJ (1992) Hypothesis: are imbalances in the calciferol endocrine system implicated? J Am Coll Nutr 11, 567–583.CrossRefGoogle ScholarPubMed
Mortimer, EA, Monson, RR & MacMahon, B (1977) Reduction in mortality from coronary heart disease in men residing at high altitude. N Engl J Med 296, 581–585.CrossRefGoogle ScholarPubMed
Muller, K, Haahr, PM, Diamant, M, Rieneck, K, Kharazmi, A & Bendtzen, K (1992) 1,25-Dihydroxyvitamin D3 inhibits cytokine production by human blood monocytes at the post-transcriptional level. Cytokine 4, 506–512.CrossRefGoogle ScholarPubMed
Muna, WF (1993) Cardiovascular disorders in Africa. World Health Stat Q 46, 125–133.Google ScholarPubMed
Murray, CJ & Lopez, AD (1997) Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 349, 1269–1276.CrossRefGoogle ScholarPubMed
Passeri, G, Pini, G, Troiano, L, Vescovini, R, Sansoni, P, Passeri, M, Gueresi, P, Delsignore, R, Pedrazzoni, M & Franceschi, C (2003) Low vitamin D status, high bone turnover, and bone fractures in centenarians. J Clin Endocrinol Metab 88, 5109–5115.CrossRefGoogle ScholarPubMed
Pepe, J, Romagnoli, E, Nofroni, I, Pacitti, MT, De Geronimo, S, Letizia, C, Tonnarini, G, Scarpiello, A, D'Erasmo, E & Minisola, S (2005) Vitamin D status as the major factor determining the circulating levels of parathyroid hormone: a study in normal subjects. Osteoporos Int 16, 805–812.CrossRefGoogle ScholarPubMed
Pfeifer, M, Begerow, B, Minne, HW, Nachtigall, D & Hansen, C (2001) Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab 86, 1633–1637.Google ScholarPubMed
Price, PA, Faus, SA & Williamson, MK (2000) Warfarin-induced artery calcification is accelerated by growth and vitamin D. Arterioscler Thromb Vasc Biol 20, 317–327.CrossRefGoogle ScholarPubMed
Rajakumar, K (2003) Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective. Pediatrics 112, E132–E135.CrossRefGoogle ScholarPubMed
Ramchandran, A, Snehalatha, C, Kapur, A, Vijay, V, Mohan, V, Das, AK, Rao, PV, Yajnik, CS, Prasanna, Kumar KN & Nair, JD (2001) High prevalence of diabetes and impaired glucose tolerance in India. National urban diabetes survey. Diabetologia 9, 1094–1101.CrossRefGoogle Scholar
Renaud, S & de Lorgeril, M (1992) Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet 339, 1523–1526.CrossRefGoogle ScholarPubMed
Ridker, PM, Hennekens, CH, Buring, JE & Rifai, N (2000) C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 342, 836–843.CrossRefGoogle Scholar
Rigel, DS, Rigel, EG & Rigel, AC (1999) Effects of altitude and latitude on ambient UVB radiation. J Am Acad Dermatol 40, 114–116.CrossRefGoogle ScholarPubMed
Rostand, SG (1997) Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension 30, 150–156.CrossRefGoogle ScholarPubMed
Rostand, SG & Drueke, TB (1999) Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int 56, 383–392.CrossRefGoogle ScholarPubMed
Rucker, D, Allan, JA, Fick, GH & Harley, DA (2002) Vitamin D insufficiency in a population of healthy western canadians. CMAJ 166, 1517–1524.Google Scholar
Schurgers, LJ, Dissel, PE, Spronk, HM, Soute, BA, Dhore, CR, Cleutjens, JP & Vermmer, C (2001) Role of vitamin K and vitamin K-dependent proteins in vascular calcification. Z Kardiol 90, Suppl. 3, 57–63.CrossRefGoogle ScholarPubMed
Scragg, R (1981) Seasonality of cardiovascular disease mortality and the possible protective effect of ultra-violet radiation. Int J Epidemiol 10, 337–341.CrossRefGoogle ScholarPubMed
Scragg, R (1982) Seasonal variation in mortality in Queensland. Community Health Stud 6, 120–129.CrossRefGoogle Scholar
Scragg, R, Khaw, KT & Murphy, S (1995) Effect of winter oral vitamin D3 supplementation on cardiovascular risk factors in elderly adults. Eur J Clin Nutr 49, 640–646.Google ScholarPubMed
Shanahan, CM & Weissberg, PL (1998) Smooth muscle cell heterogeneity: patterns of gene expression in vascular smooth muscle cells in vitro and in vivo. Arterioscler Thrombos Vasc Biol 18, 333–338.CrossRefGoogle ScholarPubMed
Shi-Kuang, P, Bruce, TC, Philip, T & Belma, M (1976) Role of mild excess of vitamin D3 in arteriosclerosis: a study in squirrel monkeys. Arterial Wall 4, 229–249.Google Scholar
Shoji, T, Shinohara, K, Kimoto, E et al. , (2004) Lower risk for cardiovascular mortality in oral 1alpha-hydroxy vitamin D3 users in a haemodialysis population. Nephrol Dial Transplant 19, 179–184.CrossRefGoogle Scholar
Simpson, RU & Weishaar, RE (1988) Involvement of 1,25-dihydroxyvitamin D3 in regulating myocardial calcium metabolism: physiological and pathological actions. Cell Calcium 9, 285–292.CrossRefGoogle ScholarPubMed
Singh, RB, Niaz, MA, Ghosh, S, Beegom, R, Agarwal, P, Nangia, S, Moshiri, M & Janus, ED (1998) Low fat intake and coronary artery disease in a population with higher prevalence of coronary artery disease: the Indian paradox. J Am Coll Nutr 17, 342–350.CrossRefGoogle Scholar
Souci, SW, Fachmann, W & Kraut, H (1994) Die Zusammensetzung der Lebensmittel - Nährwerttabellen (The Composition of Food – Tables of Nutritional Values). Stuttgart, Germany: Wissenschaftliche Verlagsgesellschaft.Google Scholar
Spiess, TD (1932) Production of nonfatal vascular sclerosis in rabbits by means of viosterol (irradiated ergosterol). Arch Intern Med 50, 443–449.CrossRefGoogle Scholar
Stack, AG & Bloembergen, WE (2001) Prevalence and clinical correlates of coronary artery disease among new dialysis patients in the United States: a cross-sectional study. J Am Soc Nephrol 12, 1516–1523.CrossRefGoogle ScholarPubMed
Takeo, S, Anan, M, Fujioka, K, Kajihara, T, Hiraga, S, Miyake, K, Tanoka, K, Minematsu, R, Mori, H & Taniguchi, Y (1989) Functional changes of aorta with massive accumulation of calcium. Arteriosclerosis 77, 175–181.CrossRefGoogle ScholarPubMed
Tangpricha, V, Pearce, EN, Chen, TC & Holick, MF (2002) Vitamin D insufficiency among free-living healthy young adults. Am J Med 112, 659–662.CrossRefGoogle ScholarPubMed
Timms, PM, Mannan, N, Hitman, GA, Noonan, K, Mills, PG, Syndercombe-Court, D, Aganna, E, Price, CP & Boucher, BJ (2002) Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 95, 787–796.CrossRefGoogle ScholarPubMed
van den Berghe, G, Van Roosbroeck, D, Vanhove, P, Wouters, PJ, De Pourcq, L & Bouillon, R (2003) Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab 88, 4623–4632.CrossRefGoogle ScholarPubMed
Van Lente, F (2000) Markers of inflammation as predictors in cardiovascular disease. Clin Chim Acta 293, 31–52.CrossRefGoogle Scholar
Vieth, R (2002) Vitamin D ingestion and changes to rat aorta. Cardiovascular Res 56, 323–324.CrossRefGoogle ScholarPubMed
Vieth, R, Cole, DE, Hawker, GA, Trang, HM & Rubin, LA (2001) Wintertime vitamin D insufficiency is common in young Canadian women, and their vitamin D intake does not prevent it. Eur J Clin Nutr 55, 1091–1097.CrossRefGoogle ScholarPubMed
Vieth, R, Kimball, S, Hu, A & Walfish, PG (2004) Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutr J 3, 8.CrossRefGoogle ScholarPubMed
Vieth, R, Ladak, Y & Walfish, PG (2003) Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88, 185–191.CrossRefGoogle ScholarPubMed
Vik, T, Try, K & Stromme, JH (1980) The vitamin D status of man at 70 degrees north. Scand J Clin Lab Invest 40, 227–232.CrossRefGoogle Scholar
Watson, KE, Abroiat, ML, Malone, LL, Hoed, JM, Doherty, T, Detrano, R & Demer, LL (1997) Active serum vitamin D levels are inversely correlated with coronary calcification. Circulation 96, 1755–1760.CrossRefGoogle ScholarPubMed
Woitge, HW, Knothe, A, Witte, K, Schmidt-Gayk, H, Ziegler, R, Lemmer, B & Seibel, MJ (2000) Circaannual rhythms and interactions of vitamin D metabolites, parathyroid hormone, and biochemical markers of skeletal homeostasis: a prospective study. J Bone Miner Res 15, 2443–2450.CrossRefGoogle ScholarPubMed
Wortsman, J, Matsuoka, LY, Chen, TC, Lu, Z & Holick, MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72, 690–693.CrossRefGoogle ScholarPubMed
Yancy, WS Jr, Westman, EC, French, PA & Califf, RM (2003) Diets and clinical coronary events: the truth is out there. Circulation 107, 10–16.CrossRefGoogle ScholarPubMed
Yudkin, JS, Yajnik, CS, Mohamed-Ali, V & Bulmer, K (1999) High levels of circulating proinflammatory cytokines and leptin in urban, but not rural, Indians. A potential explanation for increased risk of diabetes and coronary heart disease. Diabetes Care 22, 363–364.CrossRefGoogle Scholar
Yusuf, A, Reddy, S, Ounpuu, S & Anand, S (2001) Global burden of cardiovascular diseases part I: General considerations, the epidemiologic transition, risk factors, and impact or urbanization. Circulation 104, 2746–2753.CrossRefGoogle ScholarPubMed
Zittermann, A (1987) Vitamin D Status von Patienten mit hereditären Aminosäurestoffwechselstörungen und von Patienten mit Phenylketonurie (Vitamin D status in patients with hereditary disturbances in amino acid metabolism and in patients with phenylketonuria). PhD Thesis, Bonn, Germany.Google Scholar
Zittermann, A (2003 a) Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr 89, 552–572.CrossRefGoogle ScholarPubMed
Zittermann, A (2003 b) Serum 25-hydroxyvitamin D response to oral vitamin D intake in children. Am J Clin Nutr 78, 496–497.CrossRefGoogle ScholarPubMed
Zittermann, A, Dembinski, J & Stehle, P (2004) Low vitamin D status is associated with low cord blood levels of the immunosuppressive cytokine interleukin-10. Pediatr Allergy Immunol 15, 242–246.CrossRefGoogle ScholarPubMed
Zittermann, A, Sabatschus, O, Jantzen, S, Platen, P, Danz, A, Dimitriou, T, Scheld, K, Klein, K & Stehle, P (2000) Exercise-trained young men have higher calcium absorption rates and plasma calcitriol levels in comparison to age-matched sedentary controls. Calcif Tissue Int 67, 215–219.CrossRefGoogle Scholar
Zittermann, A, Scheld, K & Stehle, P (1998) Seasonal variations in vitamin D status and calcium absorption do not influence bone turnover in young women. Eur J Clin Nutr 52, 501–506.CrossRefGoogle Scholar
Zittermann, A, Schulze, Schleithoff S, Tenderich, G, Berthold, HK, Körfer, R & Stehle, P (2003) Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 41, 105–112.CrossRefGoogle ScholarPubMed