Vitamin D Status and Risk of Cardiovascular Events Lessons Learned via Systematic Review and Meta-Analysis

被引:55
|
作者
Sokol, Seth I. [1 ]
Tsang, Pansy [3 ]
Aggarwal, Vikas
Melamed, Michal L. [2 ,4 ]
Srinivas, V. S. [5 ]
机构
[1] Jacobi Med Ctr, Div Cardiol, Dept Med, Bronx, NY 10461 USA
[2] Albert Einstein Coll Med, Div Nephrol, Bronx, NY 10467 USA
[3] NYU, Sch Med, Dept Med, New York, NY USA
[4] Albert Einstein Coll Med, Dept Epidemiol & Populat Hlth, Bronx, NY 10467 USA
[5] Montefiore Med Ctr, Div Cardiol, Bronx, NY 10467 USA
关键词
vitamin D; cardiovascular events; systematic review; meta-analysis; D DEFICIENCY; 25-HYDROXYVITAMIN D; ALL-CAUSE; CALCITRIOL BLUNTS; DISEASE MORTALITY; NATIONAL-HEALTH; ASSOCIATION; ANALOGS;
D O I
10.1097/CRD.0b013e31821da9a5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Accumulating data linking hypovitaminosis D to cardiovascular (CV) events has contributed to large increases in vitamin D testing and supplementation. To evaluate the merits of this practice, we conducted a systematic review with meta-analysis providing a framework for interpreting the literature associating hypovitaminosis D with increased CV events. Prospective studies were identified by search of MEDLINE and EMBASE from inception to January 2010, restricted to English language publications. Two authors independently extracted data and graded study quality. Pooled relative risks (RR) were calculated using a random effects model. Ten studies met criteria for review and 7 were included in meta-analysis. Pooled RR for CV events using FAIR and GOOD quality studies was 1.67 (95% confidence interval, 1.23-2.28) during an average follow-up of 11.8 years. There was evidence of significant heterogeneity across studies (Q statistics = 16.6, P = 0.01, I-2 = 63.8%), which was eliminated after omitting 2 studies identified by sensitivity analysis (RR, 1.34 [1.08-1.67]; P for heterogeneity = 0.33). When restricting analysis to GOOD quality studies (RR, 1.27 [1.04-1.56]), no significant heterogeneity was found (P = 0.602). Systematic review identified significant shortcomings in the literature, including variability in defining vitamin D status, seasonal adjustments, defining and determining CV outcomes, and the use of baseline vitamin D levels. In conclusion, a modest increased risk of CV events associated with hypovitaminosis D is tempered by significant limitations within the current literature. These findings underscore the importance of critical appraisal of the literature, looking beyond reported risk estimates before translating results into clinical practice.
引用
收藏
页码:192 / 201
页数:10
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