For decades,
observational studies has provided
evidence of the association between reduced levels of 25-hydroxy vitamin D and
increased risk of cardiovascular disease. It is generally accepted that vitamin
D deficiency is in some way related to adverse cardiovascular outcomes.
It has been postulated that this association may be a result of reverse
causality in which unhealthy and less mobile individuals are less likely to be
exposed to sunlight , or perhaps due to a physiological chain of events in
which low vitamin D concentrations promote downstream vascular remodeling andhemodynamic instability.And yet,
after thousands of studies have been published on the topic, the global medical
community remains very much in the dark regarding whether a true relationship
exists between vitamin D deficiency and increased cardiovascular risk.
A small
number of clinical trials which have aimed to assess the possibility of a
direct, causal relationship between low vitamin D concentrations and poor
cardiovascular outcomes in select patient populations do exist. Unfortunately,
metaanalyses of these trials demonstrate widespread inconsistency in trial
duration, sample size, type of vitamin D intervention and route of
administration, and primary outcomes. As a result, the medical landscape
is barren of vitamin D trials with consistent, pragmatic designs formulated a
priori to assess cardiovascular outcomes and thus the depth of knowledge of
vitamin D has remained stagnant.