Can Vitamin D Deficiency Break Your Heart?
2012; Elsevier BV; Volume: 87; Issue: 4 Linguagem: Inglês
10.1016/j.mayocp.2011.12.013
ISSN1942-5546
AutoresJames H. O’Keefe, Harshal Patil, Carl J. Lavie,
Tópico(s)Sodium Intake and Health
ResumoWe congratulate Hoang et al1Hoang M.T. Defina L.F. Willis B.L. Leonard D.S. Weiner M.F. Brown E.S. Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center Longitudinal Study.Mayo Clin Proc. 2011; 86: 1050-1055Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar from the Cooper Center Longitudinal Study on their article reporting a significant association between low serum 25-hydroxyvitamin D [25(OH)D] levels and depression among the largest group of individuals in whom this potential link has been explored to date. The fact that this study was done as part of a medical student summer research program makes it even more impressive. In the same issue of Mayo Clinic Proceedings, Chamberlain et al2Chamberlain A.M. Vickers K.S. Colligan R.C. Weston S.A. Rummans T.A. Roger V.L. Associations of preexisting depression and anxiety with hospitalization in patients with cardiovascular disease.Mayo Clin Proc. 2011; 86: 1056-1062Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar report that among a cohort of patients with preexisting cardiovascular (CV) disease, depression independently predicted hospitalization and all-cause mortality over a 17-year follow-up period. We have recently documented strong independent associations between low vitamin D levels and adverse CV events,3O'Keefe J.H. Lavie C.J. Holick M.F. Vitamin D supplementation for cardiovascular disease prevention.JAMA. 2011; 306 (author reply 1547-1548): 1546-1547Crossref PubMed Scopus (24) Google Scholar, 4Lee J.H. O'Keefe J.H. Bell D. Hensrud D.D. Holick M.F. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor?.J Am Coll Cardiol. 2008; 52: 1949-1956Abstract Full Text Full Text PDF PubMed Scopus (606) Google Scholar, 5Lavie C.J. Lee J.H. Milani R.V. Vitamin D and cardiovascular disease: will it live up to its hype?.J Am Coll Cardiol. 2011; 58: 1547-1556Abstract Full Text Full Text PDF PubMed Scopus (161) Google Scholar and some meta-analyses show that vitamin D supplementation appears to significantly lower all-cause mortality,6Bjelakovic G. Gluud L.L. Nikolova D. et al.Vitamin D supplementation for prevention of mortality in adults.Cochrane Database Syst Rev. 2011; (CD007470)Google Scholar whereas others do not.7Elamin M.B. Abu Elnour N.O. Elamin K.B. et al.Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis.J Clin Endocrinol Metab. 2011; 96: 1931-1942Crossref PubMed Scopus (336) Google Scholar Thus, it is biologically plausible that vitamin D deficiency–induced depression may, in part, be responsible for increased CV risk associated with low vitamin D levels. Additionally, the tendency for depressed patients to stay indoors and be physically inactive (both risk factors for vitamin D deficiency) may lead to low vitamin D levels, which, in turn, are associated with increased CV risk.2Chamberlain A.M. Vickers K.S. Colligan R.C. Weston S.A. Rummans T.A. Roger V.L. Associations of preexisting depression and anxiety with hospitalization in patients with cardiovascular disease.Mayo Clin Proc. 2011; 86: 1056-1062Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Although the study from Hoang et al1Hoang M.T. Defina L.F. Willis B.L. Leonard D.S. Weiner M.F. Brown E.S. Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center Longitudinal Study.Mayo Clin Proc. 2011; 86: 1050-1055Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar demonstrates that the association between low 25(OH)D levels was independent of physical activity, we were surprised that these Cooper Center Longitudinal Study data were also not corrected for precisely measured levels of cardiorespiratory fitness. Vitamin D deficiency, besides being associated with depression, appears to increase the risk of developing inflammation, insulin resistance, diabetes, and atherosclerosis, and also activates the renin-angiotensin-aldosterone system, which predisposes to hypertension and left ventricular hypertrophy.3O'Keefe J.H. Lavie C.J. Holick M.F. Vitamin D supplementation for cardiovascular disease prevention.JAMA. 2011; 306 (author reply 1547-1548): 1546-1547Crossref PubMed Scopus (24) Google Scholar, 4Lee J.H. O'Keefe J.H. Bell D. Hensrud D.D. Holick M.F. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor?.J Am Coll Cardiol. 2008; 52: 1949-1956Abstract Full Text Full Text PDF PubMed Scopus (606) Google Scholar, 5Lavie C.J. Lee J.H. Milani R.V. Vitamin D and cardiovascular disease: will it live up to its hype?.J Am Coll Cardiol. 2011; 58: 1547-1556Abstract Full Text Full Text PDF PubMed Scopus (161) Google Scholar All of these consequences of vitamin D deficiency, including depression, can adversely affect CV health and longevity (Figure). An abnormally low vitamin D level, as defined by a serum 25(OH)D level less than or equal to 20 ng/mL, is present in 42% of the overall American adult population, 82% of black individuals, and 69% of the Hispanic population.3O'Keefe J.H. Lavie C.J. Holick M.F. Vitamin D supplementation for cardiovascular disease prevention.JAMA. 2011; 306 (author reply 1547-1548): 1546-1547Crossref PubMed Scopus (24) Google Scholar The average 25(OH)D level in adults is 20 ng/mL8Forrest K.Y. Stuhldreher W.L. Prevalence and correlates of vitamin D deficiency in US adults.Nutr Res. 2011; 31: 48-54Abstract Full Text Full Text PDF PubMed Scopus (601) Google Scholar; a long-term daily intake of an additional 100 IU of vitamin D will increase this level by only about 1 ng/mL.3O'Keefe J.H. Lavie C.J. Holick M.F. Vitamin D supplementation for cardiovascular disease prevention.JAMA. 2011; 306 (author reply 1547-1548): 1546-1547Crossref PubMed Scopus (24) Google Scholar, 4Lee J.H. O'Keefe J.H. Bell D. Hensrud D.D. Holick M.F. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor?.J Am Coll Cardiol. 2008; 52: 1949-1956Abstract Full Text Full Text PDF PubMed Scopus (606) Google Scholar, 5Lavie C.J. Lee J.H. Milani R.V. Vitamin D and cardiovascular disease: will it live up to its hype?.J Am Coll Cardiol. 2011; 58: 1547-1556Abstract Full Text Full Text PDF PubMed Scopus (161) Google Scholar Thus, supplementing the diet by the 600 to 800 IU daily as recommended by the Institute of Medicine's new guidelines9Ross A.C. Taylor C.L. Yaktine A.L. Del Valle H.B. Dietary Reference Intakes for Calcium and Vitamin D. The National Academies Press, Washington, DC2011Google Scholar would be expected to raise adult Americans' mean vitamin D levels to 26 to 28 ng/mL, which is still in the insufficient range (<30 ng/mL). Recently, the Endocrine Society clinical practice guidelines10Holick M.F. Binkley N.C. Bischoff-Ferrari H.A. et al.Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab. 2011; 96: 1911-1930Crossref PubMed Scopus (6794) Google Scholar suggested doses of 1000 to 2000 IU of vitamin D3 daily, which are much more likely to achieve a 25(OH)D level of at least 30 ng/mL. Insufficient vitamin D causes musculoskeletal pain and weakness, and supplementing low 25(OH)D levels back into the normal ranges has been shown unequivocally to improve integrity and strength of bones and muscles and to reduce falls.4Lee J.H. O'Keefe J.H. Bell D. Hensrud D.D. Holick M.F. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor?.J Am Coll Cardiol. 2008; 52: 1949-1956Abstract Full Text Full Text PDF PubMed Scopus (606) Google Scholar, 5Lavie C.J. Lee J.H. Milani R.V. Vitamin D and cardiovascular disease: will it live up to its hype?.J Am Coll Cardiol. 2011; 58: 1547-1556Abstract Full Text Full Text PDF PubMed Scopus (161) Google Scholar Large randomized controlled trials are under way, and these should help to determine whether raising low vitamin D levels will also reduce risks for CV events, depression, and death. These results are not expected for several years (at least 3 years and possibly 5 years or more), and in the meanwhile it seems prudent to recommend a daily intake of 1500 to 2000 IU of vitamin D3 for most American adults. Recent data, including those from Mayo Clinic Proceedings,1Hoang M.T. Defina L.F. Willis B.L. Leonard D.S. Weiner M.F. Brown E.S. Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center Longitudinal Study.Mayo Clin Proc. 2011; 86: 1050-1055Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, 2Chamberlain A.M. Vickers K.S. Colligan R.C. Weston S.A. Rummans T.A. Roger V.L. Associations of preexisting depression and anxiety with hospitalization in patients with cardiovascular disease.Mayo Clin Proc. 2011; 86: 1056-1062Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar suggest that measuring vitamin D levels and normalizing deficiencies may be especially important for individuals with a history of depression and/or CV disease. In replyMayo Clinic ProceedingsVol. 87Issue 4PreviewWe thank O'Keefe et al for their interest in our report on the association between serum hydroxyvitamin D and current depressive symptoms.1 Lack of cardiorespiratory fitness (CRF) has been associated with depressive symptoms. For example, previous studies from the Aerobics Center Longitudinal Study found a significant inverse dose-response relationship between maximal CRF and depressive symptoms.2,3 The current study focused on depressive symptoms and their relationship to serum hydroxyvitamin D from a psychiatric perspective. 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