Coronary Artery Disease and Its

Association with Vitamin D

Deficiency

Source:
J Midlife Health 2016;7:56-60

Writers:
Ramesh Aggarwal, Tauseef Akhthar,
Sachin Kumar Jain

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Presented by:
Samdaniel Sutanto 112016350

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INTRODUCTION
Coronary artery disease (CAD) is one of the major life-
threatening disease and major cause of death worldwide

Acute coronary syndrome is responsible for most of mortalities

Traditional risk factors including tobacco, diet, physical

inactivity, dyslipidemia, obesity, hypertension, diabetes mellitus

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There is an evidence of vitamin D deficiency may play a role in
pathogenesis of CAD

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VITAMIN D

Fat-soluble vitamins, also known as sunshine vitamins

Forms of the vitamin D

Vitamin D2 (ergocalciferol)
Vitamin D3 (cholecalciferol)

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Vitamin D3 should be preferred for supplementation

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DEFINING VITAMIN D
DEFICIENCY

International Vitamin D insufficiency (<50 nmol/L)

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Vitamin D deficiency (<20 nmol/L)
Osteoporosis Recommended target level = 75
Foundation nmol/L
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VITAMIN D DEFICIENCY : A
GLOBAL PROBLEM
Widely prevalent across the globe

More severe in elderly and nursing home

residents

Several factors are involved

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Decreased sunshine
Cultural avoidance of skin exposure
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ROLE OF VITAMIN D DEFICIENCY IN THE
PATHOGENESIS OF CORONARY ARTERY DISEASE (1)

Cardiac Function
Increased cardiac contractility, hypertrophy, fibrosis
Role of matrix metalloproteinase (MMP)

Hypertension
Recent publication from NHANES III found that
serum 25(OH)D was inversely associated with blood
pressure and pulse pressure

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Atherosclerosis
Promotes uptake of cholesterol by macrophages
Decrease high-density lipoprotein levels and
apolipoprotein A-1

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ROLE OF VITAMIN D DEFICIENCY IN THE
PATHOGENESIS OF CORONARY ARTERY DISEASE (2)

Inflammatory Factors
May cause plaque rupture
Initiated by inflammatory markers including C-
reactive protein, IL-6

Hyperparathyroidism
Vitamin D deficiency increase PTH
Increasing blood pressure and myocardial
contractility

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Diabetes and Metabolic Syndrome
Risk factors of CAD
Insulin resistance and pancreatic beta cell
dysfunction

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AREA OF UNCERTAINTY

Only few well-conducted randomized control trials have

failed to provide conclusive results

Association of vitamin D status and cardio-metabolic

outcome is uncertain

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There is no significant effects of vitamin D supplementation
on blood pressure and other cardiovascular risk factors

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CONCLUSION
Vitamin D deficiency appears to be involved in
the pathogenesis of CAD at several steps

Large-scale well-randomized control trials are

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needed to prove that Vitamin D supplementation
improves the cardiovascular outcomes

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 THANK YOU

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