Vitamin D deficiency and heart disease

Vitamin D deficiency is present in the vast majority of patients with chronic kidney disease (CKD), and correcting a poor vitamin D status is recommended as a treatment of CKD–mineral and bone disorders. In this review, we summarize the molecular and clinical data on the role of vitamin D status for heart diseases and its risk factors, with particular attention to patients with CKD. Experimental studies strongly suggest that vitamin D metabolism has a crucial role in myocardial and vascular pathophysiology. This is supported by observations of vitamin D receptor knockout mice, which suffer from myocardial hypertrophy and arterial hypertension with increased activity of the renin–angiotensin system. In the general population and in particular in CKD patients, a poor vitamin D status is associated with cardiovascular (CV) risk factors and preclinical manifestations of CV disease including coronary calcification. Poor vitamin D status is also associated with prevalent and incident CV diseases, such as heart failure and sudden cardiac death. Native as well as active vitamin D treatments improve CV risk profiles and exert beneficial effects on parameters of myocardial structure and function. Whether vitamin D therapy is effective for the prevention or treatment of CV disease remains to be proven in large-scale randomized controlled trials. Native vitamin D should, however, be supplemented in virtually all CKD patients with reduced 25-hydroxyvitamin D concentrations, and the promising data on antiproteinuric and cardioprotective effects of paricalcitol may extend the future indication spectrum for active vitamin D treatment.