The Impact of Obesity on the Association between Vitamin D Deficiency and Cardiovascular Disease

Abstract

The aim of this article is to review the literature regarding the relationship between vitamin D deficiency and cardiovascular disease (CVD) and its modification in the presence of obesity. Despite the strong association between vitamin D status and cardiovascular outcomes, vitamin D supplementation trials in the general population have failed to decrease the incidence of cardiovascular events and mortality. A comprehensive study of the published literature and a comparison with experimental data lead to the conclusion that obesity, due to its high prevalence and strong association with both vitamin D deficiency and CVD, may act as a critical confounder, which is responsible for the different results on this association. Adoption of a vitamin D preventive supplementation strategy for CVD is unlikely to yield any benefit to the general population. However, it might be particularly useful in obese adults with increased risk for CVD.

Keywords: atherosclerosis; cardiovascular disease; obesity; vitamin D.

Figure 1

Proposed effects of vitamin D on obesity-related atherosclerotic progression. Vitamin D prevents further macrophage recruitment in atherosclerotic lesions and decreases vascular inflammation through inhibition of nuclear factor kappa B and decoying of reactive oxygen species. Obesity alleviates the beneficial effects of vitamin D on the vasculature by decreasing vitamin D bioavailability and augmenting the production of reactive oxygen species.