Дефицит витамина D и сердечно-сосудистая патология
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Ключевые слова: дефицит витамина D, 25(ОН)D, 1,25(OH)2D, кардиология, артериальная гипертензия, атеросклероз, нарушение сердечного ритма, хроническая сердечная недостаточность.
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Vitamin D deficiency is widespread worldwide and present in about 30–50% of population. In most cases, this problem is associated with musculoskeletal system pathology: rickets in children, and osteomalacia or osteoporosis in adults. However, in recent years, convincing data was obtained on the links between vitamin D deficiency and cardiovascular pathology. Low Vitamin D levels in humans are associated with the unfavorable cardiovascular risk factors, such as arterial hypertension (AH), diabetes mellitus, and dyslipidemia, which are the predictors of the severe cardiovascular diseases, including strokes and infarctions. It has been demonstrated that vitamin D has a strong vasoptotective effect via endothelial dysfunction improvement, prevents blood vessels and myocardium remodeling, improves blood pressure parameters, reduces the risk of development of left ventricular hypertrophy, slows down fibrosis, reduces the risk of atherosclerosis, reduces insulin resistance, and also affects inflammation and immunity. This article provides data of Russian and foreign studies demonstrating the effect of Vitamin D deficiency on the development of atherosclerosis, AH, heart rhythm disorder and progression of chronic heart failure.
Keywords: Vitamin D Deficiency, 25(OH)D, 1,25(OH)2D, cardiology, arterial hypertension, atherosclerosis, heart rhythm disorder, chronic heart failure.
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4. Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168:1340-49. https://doi.org/10.1001/archinte.168.12.1340
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6. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109(Suppl 1): III27–III32. DOI: 10.1161/01.CIR. 0000131515.03336.f8
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8. Menezes AR, Lamb MC, Lavie CJ, DiNicolantonio JJ. Vitamin D and atherosclerosis. Curr Opin Cardiol. 2014;29(6):571-7. https://doi.org/10.1097/hco.0000000000000108
9. Norman PE, Powell JT. Vitamin D and Cardiovascular Disease. Circulation Research. 2014;114:379-93. https://doi.org/10.1161/circresaha. 113.301241
10. Melaku L, Mossie A. Molecular mediators and controlling mechanism of vascular calcification. Int J Clin Exp Physiol. 2017;4:3-14. https://doi.org/10.4103/ijcep.ijcep_3_17
11. Hsu JJ, Tintut Y, Demer LL. Vitamin D and osteogenic differentiation in the artery wall. Clin J Am Soc Nephrol. 2008 Sep;3(5):1542-7. https://doi.org/10.2215/cjn.01220308
12. Mayer OJr, Filipovský J, Seidlerová J, Vaněk J, Dolejšová M, Vrzalová J, Cífková R. The association between low 25-hydroxyvitamin D and increased aortic stiffness. J Hum Hypertens. 2012 Nov;26(11):650-5. https://doi.org/10.1038/jhh.2011.94
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16. Zittermann A, Schulze Schleithoff S, Tenderich G, Berthold HK, Korfer T, et al. Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol. 2003 Jan; 41:105-12. https://doi.org/10.1016/s0735-1097(02)02624-4
17. Zittermann A, Dembinski J, Stehle P. Low vitamin D status is associated with low cord blood levels of the immunosuppressive cytokine interleukin-10. Pediatr Allergy Immunol. 2004;15:242-6. https://doi.org/ 10.1111/j.1399-3038.2004.00140.x
18. Mallat Z, Besnard S, Duriez M, et al. Protective role of interleukin-10 in atherosclerosis. Circ Res. 1999;85:E17-24. https://doi.org/10.1161/ 01.res.85.8.e17
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20. Hlavatya Tibor, Krajcovicovaa Anna, Payerb Juraj. Vitamin D Therapy in Inflammatory Bowel Diseases: Who, in What Form, and How Much? J Crohn's and Colitis. 2015;198-209. https://doi.org/10.1093/ ecco-jcc/jju004
21. Dadaei T, Safapoor MH, Asadzadeh Aghdaei H, Balaii H, Pourhoseingholi MA, Naderi N, et al. Effect of vitamin D3 supplementation on TNF-α serum level and disease activity index in Iranian IBD patients. Gastroenterol Hepatol Bed Bench. 2015;8(1):49-55.
22. Lynn Kane, Kelly Moore, Dieter Lütjohann, et al. Vitamin D3 Effects on Lipids Differ in Statin and NonStatin-Treated Humans: Superiority of Free 25-OH D Levels in Detecting Relationships. J Clin Endocrinol Metab. 2013 Nov;98(11):4400-9. https://doi.org/10.1210/jc.2013-1922
23. Jegger D, da Silva R, Jeanrenaud X, Nasratullah M, Tevaearai H, von Segesser LK, Segers P, Gaillard V, Atkinson J, Lartaud I, Stergiopulo N. Ventricular-arterial coupling in a rat model of re-duced arterial compliance provoked by hypervitaminosis D and nicotine. Am J Physiol Heart Circ Physiol. 2006 Oct;291(4):H1942-51. https://doi.org/10.1152/ajpheart.00091.2006
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3. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174-80. https://doi.org/10.1001/archinte.168.11.1174
4. Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168:1340-49. https://doi.org/10.1001/archinte.168.12.1340
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6. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109(Suppl 1): III27–III32. DOI: 10.1161/01.CIR. 0000131515.03336.f8
7. Lavie CJ, Dinicolantonio JJ, Milani RV. Vitamin D and cardiovascular health. Circulation. 2013;128:2404-6. https://doi.org/10.1161/circulationaha.113.002902
8. Menezes AR, Lamb MC, Lavie CJ, DiNicolantonio JJ. Vitamin D and atherosclerosis. Curr Opin Cardiol. 2014;29(6):571-7. https://doi.org/10.1097/hco.0000000000000108
9. Norman PE, Powell JT. Vitamin D and Cardiovascular Disease. Circulation Research. 2014;114:379-93. https://doi.org/10.1161/circresaha. 113.301241
10. Melaku L, Mossie A. Molecular mediators and controlling mechanism of vascular calcification. Int J Clin Exp Physiol. 2017;4:3-14. https://doi.org/10.4103/ijcep.ijcep_3_17
11. Hsu JJ, Tintut Y, Demer LL. Vitamin D and osteogenic differentiation in the artery wall. Clin J Am Soc Nephrol. 2008 Sep;3(5):1542-7. https://doi.org/10.2215/cjn.01220308
12. Mayer OJr, Filipovský J, Seidlerová J, Vaněk J, Dolejšová M, Vrzalová J, Cífková R. The association between low 25-hydroxyvitamin D and increased aortic stiffness. J Hum Hypertens. 2012 Nov;26(11):650-5. https://doi.org/10.1038/jhh.2011.94
13. Holick MF. Vitamin D and Health: Evolution, Biologic, Functions, and Recommended Dietary Intakes for Vitamin D. Clinic Rev Bone Miner Metab. 2009;7:2-19. https://doi.org/10.1007/s12018-009-9026-x
14. Nathan Carlson, Robert Mah, Maria Aburto, Mark Jason Peters, Meagan V Dupper, Lie Hong Chen. Hypovitaminosis D. Correction and High-Sensitivity C-Reactive Protein Levels in Hypertensive Adults. Perm J. 2013 Fall;17(4):19-21. https://doi.org/10.7812/tpp/13-007
15. Liefaard MC, Ligthart S, Vitezova A, Hofman A, Uitterlinden AG, Kiefte-de Jong JC, et al. Vitamin D and C-Reactive Protein: A Mendelian Randomization Study. PLoS ONE. 2015;10(7):e0131740. https://doi.org/ 10.1371/journal.pone. 0131740
16. Zittermann A, Schulze Schleithoff S, Tenderich G, Berthold HK, Korfer T, et al. Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol. 2003 Jan; 41:105-12. https://doi.org/10.1016/s0735-1097(02)02624-4
17. Zittermann A, Dembinski J, Stehle P. Low vitamin D status is associated with low cord blood levels of the immunosuppressive cytokine interleukin-10. Pediatr Allergy Immunol. 2004;15:242-6. https://doi.org/ 10.1111/j.1399-3038.2004.00140.x
18. Mallat Z, Besnard S, Duriez M, et al. Protective role of interleukin-10 in atherosclerosis. Circ Res. 1999;85:E17-24. https://doi.org/10.1161/ 01.res.85.8.e17
19. Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2006;83:754-9. https://doi.org/ 10.1093/ajcn/83.4.754
20. Hlavatya Tibor, Krajcovicovaa Anna, Payerb Juraj. Vitamin D Therapy in Inflammatory Bowel Diseases: Who, in What Form, and How Much? J Crohn's and Colitis. 2015;198-209. https://doi.org/10.1093/ ecco-jcc/jju004
21. Dadaei T, Safapoor MH, Asadzadeh Aghdaei H, Balaii H, Pourhoseingholi MA, Naderi N, et al. Effect of vitamin D3 supplementation on TNF-α serum level and disease activity index in Iranian IBD patients. Gastroenterol Hepatol Bed Bench. 2015;8(1):49-55.
22. Lynn Kane, Kelly Moore, Dieter Lütjohann, et al. Vitamin D3 Effects on Lipids Differ in Statin and NonStatin-Treated Humans: Superiority of Free 25-OH D Levels in Detecting Relationships. J Clin Endocrinol Metab. 2013 Nov;98(11):4400-9. https://doi.org/10.1210/jc.2013-1922
23. Jegger D, da Silva R, Jeanrenaud X, Nasratullah M, Tevaearai H, von Segesser LK, Segers P, Gaillard V, Atkinson J, Lartaud I, Stergiopulo N. Ventricular-arterial coupling in a rat model of re-duced arterial compliance provoked by hypervitaminosis D and nicotine. Am J Physiol Heart Circ Physiol. 2006 Oct;291(4):H1942-51. https://doi.org/10.1152/ajpheart.00091.2006
24. Rostand SG. Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension. 1979;30:150-6. https://doi.org/10.1161/01.hyp.30.2.150
25. Martins D, Wolf M, Pan D, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007;167:1159-116524. https://doi.org/10.1001/ archinte.167.11.1159
26. Forman JP, Giovannucci E, Holmes MD, Bischoff-Ferrari HA, Tworoger SS, Willett WC, et al. Plasma 25 hydroxyvitamin D levels and risk of incident hypertension. Hypertension. 2007;49(5):1063-9. https://doi.org/10.1161/hypertensionaha.107.087288
27. [Karonova TL, Andreeva AT, Zlotnikova EK, Grineva EN. Vitamin D deficiency and arterial hypertension: what is in common? Arterial Hypertension. 2017;23(4):275-81 (In Russ.)]. https://doi.org/10.18705/1607-419x-2017-23-4-275-281
28. Forman JP, Curhan GC, Taylor EN. Plasma 25 hydroxyvitamin D levels and risk of incident hypertension among young women. Hypertension. 2008;52(5):828-32. https://doi.org/10.1161/hypertensionaha.107.087288
29. Mehta V, Agarwal S. Does Vitamin D Deficiency Lead to Hypertension? Cureus. 2017 Feb 17;9(2):e1038. https://doi.org/10.7759/cureus.1038
30. [Drapkina OM, Shepel RN. Pleiotropic effects of vitamin D. Rational Pharmacotherapy in Cardiology. 2016;12(2):227-33 (In Russ.)]. https://doi.org/10.20996/1819-6446-2016-12-2-227-233
31. Andrukhova O, Slavic S, Zeitz U, Riesen SC, Heppelmann MS, Ambrisko TD, et al. Vitamin D is a regulator of endothelial nitric oxide synthase and arterial stiffness in mice. Mol Endocrinol. 2014;28(1):53-64. https://doi.org/10.1210/me.2013-1252
32. [Kharlamov AN, Perrish AN, Gabinsky YaI, Ronne Kh, Ivanova EYu. Vitamin D in the Treatment of Cardiorenal Syndrome in Patients With Chronic Nephropathy. Kardiologiia. 2012;3:33-45 (In Russ.)].
33. Gunta SS, Thadhani RI, Mak RH. The effect of vitamin D status on risk factors for cardiovascular disease. Nature Reviews Nephrology. 2013;9(6):337-47. doi:10.1038/nrneph.2013.74
34. Nadir MA, Szwejkowski BR, Witham MD. Vitamin D and cardiovascular prevention. Cardiovasc Ther. 2010;28(4):5-12. https://doi.org/ 10.1111/j.1755-5922.2010.00192.x
35. [Filatova TE, Nizov AA, Davydov VV. Experience of treatment of male hypertension with obesity, fasting hyperglycemia and deficiency of vitamin D. I.P.Pavlov Russian Medical Biological Herald. 2017; 25(1): 69-75 (In Russ.)]. https://doi.org/10.23888/pavlovj2017169-75
36. Robert K. Scragg, Carlos A. Camargo, Jr. and Robert U. Simpson. Relation of Serum 25-Hydroxyvitamin D to Heart Rate and Cardiac Work (from the National Health and Nutrition). Am J Cardiol. 2010;105:122-8. https://doi.org/10.1016/j.amjcard.2009.08.661
37. Cerit, Levent Bermuda triangle; heart failure, atrial fibrillation, and vitamin D deficiency. J Cardiovasc Medicine. 2017;18(Issue2):121. https://doi.org/10.2459/jcm.0000000000000407
38. Shoben AB, Kestenbaum B, Levin G, et al. Seasonal variation in 25-hydroxyvitamin D concentrations in the cardiovascular health study. Am J Epidemiol. 2011;174:1363-72. https://doi.org/10.1093 /aje/kwr258
39. Zhiwei Zhang, Yajuan Yang, Chee Yuan Ng, Dandan Wang, JianlongWang, Guangping Li, Tong Liu, PhD. Meta-analysis of Vitamin D Deficiencyand Risk of Atrial Fibrillation. Clin. Cardiol. 2016;39(9):537-43. https://doi.org/10.1002/clc.22563
40. Kimie Ohkubo, Ichiro Watanabe, Yasuo Okumura, et al. Usefulness of High Sensitivity C-Reactive Protein in Predicting Recurrence of Atrial Fibrillation after Electrical Cardioversion. J Nihon Univ Med Ass. 2015;74(5):233-7. https://doi.org/10.4264/numa.74.5_233
41. Murphy NF, Stewart S, MacIntyre K, et al. Seasonal variation in morbidity and mortality related to atrial fibrillation. Int J Cardiol. 2004;97:283-8.
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ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский университет) Минздрава России, Москва, Россия
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V.I. PODZOLKOV, A.E. POKROVSKAYA, O.I. PANASENKO
Federal state Autonomous educational institution of higher professional education First Moscow state medical University named after I.M. Sechenov of Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia