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#Grand Rounds

A 21 RCT Meta-analysis: Do Vitamin D Supplements Reduce Risk of Cardiovascular Disease?

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BACKGROUND AND PURPOSE:

  • Previous observational studies suggest an association between low serum vitamin D levels and an increased risk of cardiovascular disease (CVD)
    • Limitations based on study design include lack of causational evidence due to possible confounding
  • Barbarawi et al (JAMA Cardiolology, 2019) examined whether vitamin D supplementation reduced CVD events and all-cause mortality

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • RCTs
    • Results included ≥1 year (long-term) vitamin D supplementation on CVD events and all-cause mortality
  • Data analysis
    • Random-effects models were used to report risk ratio (RRs) and 95% CIs
  • Primary outcome
    • Major adverse cardiovascular events
  • Secondary outcomes
    • Myocardial infarction
    • Stroke or cerebrovascular accident
    • CVD mortality
    • All-cause mortality

RESULTS:

  • 21 RCTs | 83,291 patients
    • 41,699 received vitamin D | 41,622 received placebo
    • Mean (SD) age of trial participants: 65.8 (8.4) years
    • 74.4% were female
  • Vitamin D supplementation, compared to placebo was not associated with reduced risk of
    • Major adverse cardiovascular events: RR 1.00 (95% CI, 0.95-1.06; P = .85)
    • Myocardial infarction: RR 1.00 (95% CI, 0.93-1.08; P = .92)
    • Stroke: RR 1.06 (95% CI, 0.98-1.15; P = .16)
    • CVD mortality: RR 0.98 (95% CI, 0.90-1.07; P = .68)
    • All-cause mortality (RR 0.97 (95% CI, 0.93-1.02; P = .23)
  • Results were not impacted by the following
    • Sex
    • Baseline 25-hydroxyvitamin D level
    • Vitamin D dosage
    • Formulation (daily vs bolus dosing)
    • Presence or absence of concurrent calcium administration

CONCLUSION:

  • Authors acknowledge limitations of this study
    • Most studies did not include prespecified CVD as endpoint | Underpowered for some CVD events | Heart failure generally not included
  • While additional larger trials would be necessary to address the above issues, the authors conclude that

… included trials, although different in their inclusion criteria, showed consistent findings of no significant benefit of vitamin D supplementation in reducing CVD events and all-cause mortality

Learn More – Primary Sources:

Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83,000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis

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Related ObG Topics:

Results from the VITAL Trial: Does Vitamin D Reduce Cardiovascular and Cancer Risk in the General Population?
More from the VITAL Trial: Do Omega-3 Fatty Acids Reduce Cardiovascular and Cancer Risk in the General Population?
Is There a Protective Association Between Vitamin D Levels and Cancer Risk?

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