Opposing the results of many observed studies suggesting a protective effect of vitamin D supplementation against future cardiovascular events, a new meta-analysis does not show such an advantage.
The likelihood of a major adverse cardiovascular event (MACE) was the same (relative risk of 1.0) when the researchers compared 41,669 subjects receiving vitamin D supplements with 41,622 others who received placebo in a meta-analysis of 21 randomized clinical trials.
"Vitamin D supplements should not be considered for prophylaxis of cardiovascular disease [CVD] including myocardial infarction and stroke," said lead author Mahmoud Barbarawi, chief resident of internal medicine at Hurley Medical Center, Michigan State University of Flint for Medscape Medical News . "Even in patients with low vitamin D levels, correcting their level does not mean that it will prevent cardiovascular outcomes."
that current findings do not exclude prescriptions here is vitamin D for other indications such as prevention of osteoporosis, osteomalacia or chronic kidney disease
The study was published online on June 1
Finding More Final Answers
Many observational studies indicate a relationship between low vitamin D levels, and increased risk of myocardial infarction, stroke, heart failure and CVD death. At the same time, the prescription of vitamin D supplements in primary care has increased, researchers note.
However, the US Preventive Services Task Force does not recommend vitamin D supplements to prevent adverse cardiovascular outcomes, citing insufficient evidence in a statement.
Historically, randomized trials looking at the addition of vitamin D and the risk of cardiovascular events were "limited and inconclusive," Barbarao and colleagues note.
The recent addition of larger literature studies has prompted them to perform a meta-analysis. Excluding these, they included 21 randomized clinical trials with at least 1 year of vitamin D supplementation. The primary combined MACE endpoint was determined in each trial. The incidence of myocardial infarction, stroke and cardiovascular mortality are secondary results
The average age is 66 years and almost 75% of the 83,291 studied are women. Mean follow-up ranges from 1 to 12 years
No significant differences found
A total of 6243 MACE cases occurred, but the frequency did not vary significantly depending on the addition of vitamin D versus placebo (relative risk, 1.0; 95) . % Confidence Interval [CI] 0.95 – 1.06; P = 0.85). For example, 2550 myocardial infarction occurred in the studies, but the relative risk between the groups was again 1.0 (95% CI, 0.93-1.08, P = .92). for impact is 1.06 (95% CI, 0.98-1.15, P = 0.16); for cardiovascular mortality is 0.98 (95% CI, 0.90-1.07, P = .68); and mortality for all causes was 0.97 (95% CI, 0.93-1.02, P = .23).
When asked if the relative equivalence of these results was unexpected, Barbaravi said: "Yes, the results are surprising, as many studies have shown a relationship between low vitamin D and cardiovascular disease, so little benefit was expected, but the result of this analysis is more real, as it comes from randomized controlled trials. "Interestingly, a potential elderly signal, vitamin D addition, and reduced frequency of MACE in meta-regression analysis ene P = .04).
Older people have a higher risk of cardiovascular disease, and the potential for lowering vitamin D levels is higher, so giving vitamin D to this group of patients could help, "said Barbaraou. "Indeed, large randomized trials that focus on this patient group are needed because the data on elderly patients in our study are low, so this should be interpreted with caution."
Many of the studies included do not predict cardiovascular outcomes, a potential limitation. In addition, few studies include heart failure as an endpoint.
Barbarao and his colleagues plan to study the effects of vitamin D on people with diabetes.
A "Precautious" Conclusion
The Barbarai et al. Report in this issue of JAMA Cardiology supports efforts aimed at limiting the wasteful costs of testing and treating vitamin D in populations "Arshed A Quyyumi, MD, and Ibhar Al Mheid, MD, write in an accompanying invited comment entitled" The lack of vitamin D for cardiovascular protection ". with chronic kidney disease and hyperparathyroidism is definitely indicated and such therapy has established cardiovascular benefits including lowering blood pressure, reducing electrolyte disturbances and generally reducing cardiovascular mortality. In hemodialysis patients, Quyyumi and Mheid noted, both associated with the Department of Cardiology, Emory, the Cardiovascular Clinical Institute at Emory University Medical University in Atlanta, Georgia.
"The authors cautiously conclude that adding vitamin D is not associated with a reduced risk of major adverse cardiovascular events, myocardial infarction, cerebrovascular accidents, cardiovascular mortality or mortality for all causes, indicating limitations in their analysis, "they noted. "Only 4 of the 21 studies included had pre-defined GCC endpoints and generally were mostly inadequate for GCC events." Barbarawi, Quiumi and Maid have not revealed any relevant financial dealings.
Yama Cardio. Posted Online June 19, 2019 Summary, Comment