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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RxCowboy

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#1
There are doggone few things, outside of vitamin deficiencies, that there is actual evidence that vitamins treat or prevent. From Jama Cardiology:

Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83,000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis
Mahmoud Barbarawi, MD; Babikir Kheiri, MD, MRCP, PGDip; Yazan Zayed, MD; et al

JAMA Cardiol. Published online June 19, 2019. doi:10.1001/jamacardio.2019.1870

Key Points
Question Does vitamin D supplementation have any association with cardiovascular disease risk?

Findings In this meta-analysis of randomized clinical trials that included more than 83?000 participants, vitamin D supplementation was not associated with reduced risks of major adverse cardiovascular events, myocardial infarction, stroke, cardiovascular disease mortality, or all-cause mortality compared with placebo.

Meaning These results suggest that vitamin D supplementation may not confer cardiovascular protection and may not be indicated for this purpose.

Abstract
Importance Observational studies have reported an association between low serum vitamin D levels and elevated risk of cardiovascular disease (CVD) events, but such studies cannot prove causation because of possible unmeasured confounding.

Objective We conducted a meta-analysis of randomized clinical trials that tested the association of vitamin D supplementation with reduced CVD events and all-cause mortality.

Data Sources Literature search through PubMed, the Cochrane Library, and Embase was completed by 2 reviewers from each database’s inception to December 15, 2018.

Study Selection Inclusion criteria were randomized clinical trials that reported the effect of long-term (=1 year) vitamin D supplementation on CVD events and all-cause mortality. Studies that did not include cardiovascular outcomes were excluded.

Data Extraction and Synthesis Data were abstracted independently by 2 authors. Random-effects models were used to report the risk ratios (RRs) and 95% CIs.

Main Outcomes and Measures Major adverse cardiovascular events was the primary outcome, and rates of myocardial infarction, stroke or cerebrovascular accident, CVD mortality, and all-cause mortality were the secondary end points.

Results Twenty-one randomized clinical trials were included (including 83?291 patients, of whom 41?669 received vitamin D and 41?622 received placebos). The mean (SD) age of trial participants was 65.8 (8.4) years; 61?943 (74.4%) were female. Only 4 trials had prespecified CVD as a primary end point. Vitamin D supplementation compared with placebo was not associated with reduced major adverse cardiovascular events (RR, 1.00 [95% CI, 0.95-1.06]; P=.85) nor the secondary end points of 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), or all-cause mortality (RR, 0.97 [95% CI, 0.93-1.02]; P=.23). Results were generally consistent by sex, baseline 25-hydroxyvitamin D level, vitamin D dosage, formulation (daily vs bolus dosing), and presence or absence of concurrent calcium administration.

Conclusions and Relevance In this updated meta-analysis, vitamin D supplementation was not associated with reduced major adverse cardiovascular events, individual CVD end points (myocardial infarction, stroke, CVD mortality), or all-cause mortality. The findings suggest that vitamin D supplementation does not confer cardiovascular protection and is not indicated for this purpose.
 

RxCowboy

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#3
RX--just curious--do you take any supplements or recommend them to any family or friends, if asked?
Yes, I do. There are a couple that I recommend, too.

I've recommended glucosamine (without chondroitin) to patients who are on warfarin (Coumadin) who have osteoarthritis.

There is some decent evidence that St. John's wort is as effective as SSRIs for mild--moderate depression (the kind without suicidal ideation, that would be treated in a family medicine clinic). The only problem with it is that it has so many drug interactions that patients need to be carefully screened for drug interactions.

There is some dang good evidence for melatonin for jet lag and shift-work insomnia.

Calcium with vit D prevents osteoporosis in people who are at increased risk, which I am for a number of different reasons so I take Cal+D every day.

If there are specifics I would be happy to give you my opinions/data.
 

NotOnTV

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#5
What pisses me off is getting hit with the non-covered, $125 Vitamin D lab test as part of a "wellness" workup when it's been long established that I have been taking 1000 IU of D3 daily for 15 years. Never again.
 

kaboy42

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#10
No data on that usage that I can find.

Statins cause depletion of CoQ-10. In Europe it is common for people on statins to take CoQ-10 along with a statin, but there is no data showing a benefit of any kind.
Thanks for the quick feedback sir! :thumbup:

47 yrs old and on zero meds. Just in the gym 5 out of 7 days and experience minor joint pain (mainly in my elbows). Was just looking for something that might lessen the recurrence of the minor pain.
 

SLVRBK

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#12
Thanks for the quick feedback sir! :thumbup:

47 yrs old and on zero meds. Just in the gym 5 out of 7 days and experience minor joint pain (mainly in my elbows). Was just looking for something that might lessen the recurrence of the minor pain.
Tendonitis? I'm 50 and get elbow pain after workouts with curls, curl to press, lat pulldown/pullups, etc. and I'm only lifting 2-3 times a week.
 

SLVRBK

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#13
There are doggone few things, outside of vitamin deficiencies, that there is actual evidence that vitamins treat or prevent. From Jama Cardiology:

Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83,000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis
Mahmoud Barbarawi, MD; Babikir Kheiri, MD, MRCP, PGDip; Yazan Zayed, MD; et al

JAMA Cardiol. Published online June 19, 2019. doi:10.1001/jamacardio.2019.1870

Key Points
Question Does vitamin D supplementation have any association with cardiovascular disease risk?

Findings In this meta-analysis of randomized clinical trials that included more than 83?000 participants, vitamin D supplementation was not associated with reduced risks of major adverse cardiovascular events, myocardial infarction, stroke, cardiovascular disease mortality, or all-cause mortality compared with placebo.

Meaning These results suggest that vitamin D supplementation may not confer cardiovascular protection and may not be indicated for this purpose.

Abstract
Importance Observational studies have reported an association between low serum vitamin D levels and elevated risk of cardiovascular disease (CVD) events, but such studies cannot prove causation because of possible unmeasured confounding.

Objective We conducted a meta-analysis of randomized clinical trials that tested the association of vitamin D supplementation with reduced CVD events and all-cause mortality.

Data Sources Literature search through PubMed, the Cochrane Library, and Embase was completed by 2 reviewers from each database’s inception to December 15, 2018.

Study Selection Inclusion criteria were randomized clinical trials that reported the effect of long-term (=1 year) vitamin D supplementation on CVD events and all-cause mortality. Studies that did not include cardiovascular outcomes were excluded.

Data Extraction and Synthesis Data were abstracted independently by 2 authors. Random-effects models were used to report the risk ratios (RRs) and 95% CIs.

Main Outcomes and Measures Major adverse cardiovascular events was the primary outcome, and rates of myocardial infarction, stroke or cerebrovascular accident, CVD mortality, and all-cause mortality were the secondary end points.

Results Twenty-one randomized clinical trials were included (including 83?291 patients, of whom 41?669 received vitamin D and 41?622 received placebos). The mean (SD) age of trial participants was 65.8 (8.4) years; 61?943 (74.4%) were female. Only 4 trials had prespecified CVD as a primary end point. Vitamin D supplementation compared with placebo was not associated with reduced major adverse cardiovascular events (RR, 1.00 [95% CI, 0.95-1.06]; P=.85) nor the secondary end points of 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), or all-cause mortality (RR, 0.97 [95% CI, 0.93-1.02]; P=.23). Results were generally consistent by sex, baseline 25-hydroxyvitamin D level, vitamin D dosage, formulation (daily vs bolus dosing), and presence or absence of concurrent calcium administration.

Conclusions and Relevance In this updated meta-analysis, vitamin D supplementation was not associated with reduced major adverse cardiovascular events, individual CVD end points (myocardial infarction, stroke, CVD mortality), or all-cause mortality. The findings suggest that vitamin D supplementation does not confer cardiovascular protection and is not indicated for this purpose.
@RxCowboy I shared an article on this study with my wife, she came back with an article about Vitamin D deficiency in a large percentage (75%+) of the population.

Do you have any info on this?
 

RxCowboy

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#14
@RxCowboy I shared an article on this study with my wife, she came back with an article about Vitamin D deficiency in a large percentage (75%+) of the population.

Do you have any info on this?
Yep, it's true. That's one of the reasons the article in the OP was done, because VitD deficiency has been associated with a number of health risks, including cardiovascular disease and cancer. But a deficiency being associated with a health risk doesn't necessarily follow that given a supplement will decrease the risk. It likely requires correction of the underlying cause of the deficiency, which in the United States is obesity and sedentary lifestyles (i.e. sitting in front of a computer all dadgum day).

https://link.springer.com/article/10.1007/s11154-017-9424-1

Reviews in Endocrine and Metabolic Disorders

June 2017, Volume 18, Issue 2, pp 153–165

The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention
Michael F. Holick
 

Boomer.....

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#15
Thanks for the quick feedback sir! :thumbup:

47 yrs old and on zero meds. Just in the gym 5 out of 7 days and experience minor joint pain (mainly in my elbows). Was just looking for something that might lessen the recurrence of the minor pain.
Tendonitis? I'm 50 and get elbow pain after workouts with curls, curl to press, lat pulldown/pullups, etc. and I'm only lifting 2-3 times a week.
I've had similar elbow pains in the past and found some videos describing the pain and how to correct it. FYI, I've been watching Jeff (Athlean X) for years for workout tips and he is incredible at breaking down the science behind lifting.


More videos: https://www.youtube.com/results?search_query=athlean+x+elbow+pain
 

Well

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#16
But a deficiency being associated with a health risk doesn't necessarily follow that given a supplement will decrease the risk
Rx, I'm curious as to why a supplement should be taken then. What are the health benefits of a supplement?
 

RxCowboy

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#20
Here's another one. The upshot is, if you are Vit D deficient then supplements help prevent COPD exacerbations, but if you have normal Vit D they don't make any difference.

Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials.
Jolliffe DA, et al.

Thorax. 2019 Apr;74(4):337-345. doi: 10.1136/thoraxjnl-2018-212092. Epub 2019 Jan 10.

Abstract
BACKGROUND:
Randomised controlled trials (RCTs) of vitamin D to prevent COPD exacerbations have yielded conflicting results.Individual participant data meta-analysis could identify factors that explain this variation.

METHODS:
PubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched from inception up to and including 5 October 2017 to identify RCTs of vitamin D supplementation in patients with COPD that reported incidence of acute exacerbations. Individual participant data meta-analysis was performed using fixed effects models adjusting for age, sex, Global Initiative for Chronic Obstructive Lung Disease spirometric grade and trial.

RESULTS:
Four eligible RCTs (total 560 participants) were identified; individual participant data were obtained for 469/472 (99.4%) participants in three RCTs. Supplementation did not influence overall rate of moderate/severe COPD exacerbations (adjusted incidence rate ratio (aIRR) 0.94, 95% CI 0.78 to 1.13). Prespecified subgroup analysis revealed that protective effects were seen in participants with baseline 25-hydroxyvitamin D levels <25 nmol/L (aIRR 0.55, 95% CI 0.36 to 0.84) but not in those with baseline 25-hydroxyvitamin D levels =25 nmol/L (aIRR 1.04, 95% CI 0.85 to 1.27; p for interaction=0.015). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (adjusted OR 1.16, 95% CI 0.76 to 1.75).

CONCLUSIONS:
Vitamin D supplementation safely and substantially reduced the rate of moderate/severe COPD exacerbations in patients with baseline 25-hydroxyvitamin D levels <25 nmol/L but not in those with higher levels.