ReviewLevels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis
Introduction
Cardiometabolic disorders including cardiovascular disease (CVD), type 2 diabetes mellitus (DM) and metabolic syndrome (MetS) are major causes of morbidity and mortality worldwide [1], [2]. Hypertension, dyslipidema, central obesity and glycaemic dysregulations are known risk factors for CVD [2]. Metabolic syndrome represents the clustering of these risk factors that together lead to increased risk of developing CVD and DM [3].
Vitamin D deficiency is also highly prevalent in different populations across the world. Studies suggest that approximately 30–50% of the adult population are at risk of vitamin D deficiency [4], [5]. The older adult population is especially vulnerable to vitamin D deficiency, due to a decreased capacity to synthesise vitamin D from sunlight [6]. Additionally, aging is associated with lower 7-dehydrocholesterol levels [7], which is a precursor required for synthesis of vitamin D in the skin.
Vitamin D is known to play an important role in bone and mineral homeostasis and has also been linked with multiple other pathophysiological mechanisms. The vitamin D binding receptor is not only expressed in tissues involved in calcium homeostasis but also found in more than 36 other tissue types [8] and vitamin D has more recently been implicated in a number of additional pathological processes. These processes include cancer, multiple sclerosis, psoriasis and the inflammatory response [9], [10], [11], supporting a role for vitamin D in delineating healthy trajectories of aging.
There is also growing evidence to support the link between abnormal levels of vitamin D and CVD and DM [4], [12], [13], [14]. However, the published literature differs substantially in terms of methodology, populations and results presented. Therefore the evidence remains inconclusive or incongruent.
We aimed, by critically appraising the current evidence, to evaluate the overall effects of vitamin D levels on potential risk of developing cardiometabolic disorders (CVD, DM and MetS). We also aimed to evaluate whether the association between vitamin D and cardiovascular disease, diabetes and metabolic syndrome would differ by type of cardiometabolic disorder, study design, gender, age and ethnicity.
Section snippets
Methods
We performed a systematic review and meta-analysis of studies that evaluate the relationship between vitamin D levels and cardiometabolic disorders in adults. We used the measurement of serum 25-hydroxy vitamin D (25OHD) as a proxy for vitamin D status [15].
Study selection
We retrieved 3952 references from the PubMed database and 4088 from Web of Knowledge databases. 1910 duplications were identified and removed, leaving a total of 6130 references (Fig. 1). Initial screening of the title and abstract resulted in the exclusion of 6049 references leaving 81 articles to source in full text. No additional references were identified from searching reference lists of the 81 full text papers. We received eight articles from authors directly, three of which were already
Discussion
Overall we found that high levels of vitamin D are associated with a 43% reduction in cardiometabolic disorders, this finding applied to all outcomes reported (CVD, DM or MetS), although at different levels of magnitude, and was independent of the study design.
The majority (85%) of the studies’ results were in agreement with this main finding.
When we evaluated the effects of vitamin D levels on the risk of the individual outcomes included we found a significant association between high levels
Ethical approval
Ethical approval was not required as this was a secondary data analysis.
Contributors
All authors participated actively in the preparation of the manuscript at all stages: search strategy, study selection, data analyses, and drafting of the manuscript.
Competing interest
None of the authors had any financial or personal conflict of interest to disclose.
Provenance
Commissioned and externally peer reviewed.
Acknowledgments
We would like to thank Samantha Johnson from Warwick University library services, for her advice and support with the search strategy.
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Oscar H. Franco as guarantor of this paper accepts full responsibility for the integrity of the data and the accuracy of the data analysis, had full access to all the data in the study, and controlled the decision to publish.