University Essay: Vitamin D and Cardiovascular Disease Relationship

This essay critically examines the existing research on the relationship between vitamin D and cardiovascular disease (CVD). It begins with an introduction highlighting the ongoing debate and lack of conclusive evidence. The essay then analyzes several key studies, including prospective cohort stu...Read More

Running head: FOOD AND NUTRITION: VITAMIN D AND CARDIOVASCULAR
DISEASE
FOOD AND NUTRITION: VITAMIN D AND CARDIOVASCULAR DISEASE
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1FOOD AND NUTRITION: VITAMIN D AND CARDIOVASCULAR DISEASE
Introduction
Despite the range of comprehensive clinical data and studies, there remains a dearth of
evidence based research demonstrating a valid, significant and convincing association between
high susceptibility of cardiovascular disease (CVD) and vitamin D. The following essay will
critically discuss upon the key findings which demonstrated by current evidence with respect to a
relationship between vitamin D and CVD.
Discussion
The prospective cohort study by Kilkkinen et al (2009)1, investigated the relationship
between a serum 25-hydroxyvitamin D levels (25(OH)D) and deaths due to cardiovascular,
coronary and cerebrovascular diseases across a sample of 6219 women and men, aged 30 years
and above, from years 1978-1980 to the years 2006 or until death. The findings, indeed
demonstrated and inverse association between cardiovascular, coronary and cerebrovascular
disease deaths and participants with serum 25 (OH)D levels greater than 60 nmol/L in the form
of hazard ratios (p = 0.005, 0.20, 0.002). However, despite the comprehensive of confounders
considered, the study overlooks the need for considering dietary vitamin D intake and multiple
follow up measures between the cohort period – which in turn, raises concerns of result validity
and trustworthiness.
Similarly, the cohort while the cohort study by Sun et al (2011)2, demonstrates the
prevalence of an inverse link between increased vitamin D consumption and CVD outcomes, but
1 Kilkkinen A, Knekt P, Aro A, Rissanen H, Marniemi J, Heliövaara M, Impivaara O, Reunanen A.
Vitamin D status and the risk of cardiovascular disease death. Am J Epidemiol. 2009 Oct 15;170(8):1032-9. doi:
10.1093/aje/kwp227.
2 Sun Q, Shi L, Rimm EB, Giovannucci EL, Hu FB, Manson JE, Rexrode KM. Vitamin D intake and risk
of cardiovascular disease in US men and women. Am J Clin Nutr. 2011 Aug;94(2):534-42. doi:
10.3945/ajcn.110.008763.

2FOOD AND NUTRITION: VITAMIN D AND CARDIOVASCULAR DISEASE
does not outline the prevalence of any significant link between 25(OH)D nmol/L and coronary
disease outcomes (p < 0.0001, p = 0.12 for nurses and 0.009 for health professionals)
respectively. Additionally, despite usage of a validated food frequency questionnaire, the
inclusion of participants with high health literacy rates (nurses and health professionals)
demonstrates an absence of result applicability and trustworthiness due to bias, as well as
difficult to transfer across patient or laymen scenarios.
Likewise, the observational study by Wood et al (2012)3, not only demonstrated the
absence of an inverse relationship between serum 25(OH)D and blood pressure (p = 0.87), blood
lipid (p = 0.49), insulin resistance (p = 0.89) and inflammatory marker (p =0.73) values (p <
0.001), but also the absence of validity and applicability with respect to the inclusion of only
females, prevalence of confounders like diet, sun exposure, age and physical activity and the
inclusion CVD risks and not outcomes.
Additionally, despite the inclusion of randomization and relatively large sample size, the
randomized controlled trial by Manson et al (2019)4, not only demonstrated a lack of significant
relationships between vitamin D supplementation and CVD risk, but also outlines the prevalence
of confounders like lack of repeated follow ups, absence of validated food frequency
questionnaires and inclusion of Black participants and CVD outcomes instead of risks.
3 Wood AD, Secombes KR, Thies F, Aucott L, Black AJ, Mavroeidi A, Simpson WG, Fraser WD, Reid
DM, Macdonald HM. Vitamin D supplementation and conventional cardiovascular risk factors: a parallel-group,
doubleblind, placebo-controlled RCT. J Clin Endocrinol Metab. 2012 Oct;97(10):3557-68. doi: 10.1210/jc.2012-
2126 4 Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Gordon D, Copeland T,
D'Agostino D, Friedenberg G, Ridge C, Bubes V, Giovannucci EL, Willett WC, Buring JE; VITAL Research
Group. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med. 2019 Jan
3;380(1):33-44. doi: 10.1056/NEJMoa1809944.

3FOOD AND NUTRITION: VITAMIN D AND CARDIOVASCULAR DISEASE
Conclusion
Thus, from the above critical review of literature, the lack of valid and convincing
evidence presenting a causal link between vitamin D status and CVD risk and outcomes is
evident. To conclude, there is thus a need to evaluate and implement further evidence based,
randomized and causal research, which can be translated in clinical practice, for the purpose of
arriving at a certified consensus.

4FOOD AND NUTRITION: VITAMIN D AND CARDIOVASCULAR DISEASE
Bibliography
Kilkkinen A, Knekt P, Aro A, Rissanen H, Marniemi J, Heliövaara M, Impivaara O, Reunanen
A. Vitamin D status and the risk of cardiovascular disease death. Am J Epidemiol. 2009 Oct
15;170(8):1032-9. doi: 10.1093/aje/kwp227
Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Gordon D, Copeland
T, D'Agostino D, Friedenberg G, Ridge C, Bubes V, Giovannucci EL, Willett WC, Buring JE;
VITAL Research Group. Vitamin D Supplements and Prevention of Cancer and Cardiovascular
Disease. N Engl J Med. 2019 Jan 3;380(1):33-44. doi: 10.1056/NEJMoa1809944.
Sun Q, Shi L, Rimm EB, Giovannucci EL, Hu FB, Manson JE, Rexrode KM. Vitamin D intake
and risk of cardiovascular disease in US men and women. Am J Clin Nutr. 2011 Aug;94(2):534-
42. doi: 10.3945/ajcn.110.008763.
Wood AD, Secombes KR, Thies F, Aucott L, Black AJ, Mavroeidi A, Simpson WG, Fraser WD,
Reid DM, Macdonald HM. Vitamin D supplementation and conventional cardiovascular risk
factors: a parallel-group, doubleblind, placebo-controlled RCT. J Clin Endocrinol Metab. 2012
Oct;97(10):3557-68. doi: 10.1210/jc.2012-2126.