Generaliti

Stages of vitamin D status 25(OH)D concentrations (nmol/L) Biochemical/clinical symptoms

Deficiency 025 Severe hyperparathyroidism, calcium malabsorption, rickets, osteomalacia,
myopathy
Insufficiency >2550.0 Elevated PTH levels, low intestinal calcium absorption rates, reduced bone
mineral density, subclinical myopathy
Hypovitaminosis D >5070 to100 Low body stores of vitamin D, slightly elevated PTH levels
Adequacy 70100 to 250 No disturbances of vitamin D-dependent functions
Toxicity >250 Intestinal calcium hyperabsorption, hypercalcemia
To convert values for 25-hydroxyvitamin D to nanograms per milliliter, divide by 2.50.

Consequently, dietary vitamin D usually contributes only 1020% to human vitamin D supply.
Cardio

Receptors for the vitamin D hormone (VDR) exist

in different cell types among them osteoblasts, myocytes,
cardiomyocytes, pancreatic -cells, vascular endothel cells,
neurons, colonocytes, and immune cells. Exist att receptori citoplasmatici ct i membranari.
In cardiac muscle
cells, a calcitriol-dependent Ca2+ binding protein and
a calcitriol-mediated rapid activation of voltage-dependent
Ca2+ channels exist [68], indicating that calcitriol plays
a pivotal role in the regulation of myocardial contractility.
It has long been recognized that people who live at higher latitudes
face an increased risk of many chronic diseases, including
common cancers (3339), multiple sclerosis (39, 40), and hypertension
(41). As early as 1941, Apperly (37) observed that people
living at higher latitudes, eg, Massachusetts and New Hampshire,
had a higher risk of dying of the most common cancers than did
people living in the South, eg, Georgia and South Carolina. In 1979,
Rostand (41) reported that people living at higher latitudes in both
the United States and Europe were at higher risk of hypertension
Krause et al (57) reported that hypertensive patients exposed
to UVB radiation for 3 mo had a 180% increase in circulating
concentrations of 25(OH)D and a 6 mm Hg decrease in their
diastolic and systolic blood pressures, results similar to those
expected if the patients had received a blood pressure medication

(Figure 6). A similar group of patients who were exposed to

ultraviolet A radiation and whose circulating concentrations of
25(OH)D did not increase continued to be hypertensive throughout
the 3-mo study.

Femei n vrst, supliment vit D: decrease in

systolic blood pressure of 9.3% (P < 0.025), and a decrease
in heart rate of 5.4% (P < 0.025).
young adults with vitamin D deficiency were at greater risk of
congestive heart failure than were their vitamin Dsufficient
counterparts

Interestingly, in two
human populations at high and moderate risk for ischemic
heart disease, serum levels of calcitriol were inversely correlated
with the extent of vascular calcification [41]. In the
general population, the presence of vascular calcification is a
predictor of poorer 5-year survival
Mecanism:

Li et al observed in a mouse model that 1,25(OH)2Dis effective in down-regulating renin and angiotensin and
thereby decreasing blood pressure.

Calcitriol is known to be a negative endocrine regulator of the RAAS

It is also well known that excess PTH levels increases
blood pressure and cardiac contractility, and leads to cardiomyocyte
hypertrophy, and interstitial fibrosis of the heart
[37]. Thus, excess PTH contributes to cardiovascular disease.
In the Tromso study men with left ventricular hypertrophy had
PTH levels of 44.1 26.2 pg/ml compared to PTH levels of
29.4 13.9 pg/ml in men without left ventricular hypertrophy
[45]. Moreover, the rate of coronary heart disease was
higher in the subjects with serum PTH >62 pg/ml than in
those with normal or low serum PTH levels.
Nivelul de citokine proinflamatorii crescut n deficiena de vit D
ICC

Heart failure (HF) is a major medical problem in the

Western world, with an increasing incidence and prevalence.
In fact recent data show that approximately 12 %
of the adult population in developed countries has HF, with
the prevalence rising to C10 % among people 70 years of
age or older [1] and in people with obesity,
Deficiena exist n populaie. In the only study that had compared the results of
the CHF patients with a control group of healthy subjects
matched for age and sex [17], CHF patients had 34% lower
25(OH)D levels than the controls.
Serum 25(OH)D levels were significantly
and inversely correlated with left ventricular function, and after 6 weeks of intravenous
treatment with 1-vitamin
D3, there were small but significant improvements in indices
of left ventricular function
Recomandri:

Moreover, it has been demonstrated that even soldiers

with a daily sun exposure of 370 min in a sunny country
such as India only had mean 25(OH)D level of 47 nmol/L
(18.8 ng/ml) in winter [57].
The Institute of Medicine reported in 1997 that the recommended
vitamin D intake was inadequate for adults over the age
of 50 y (69). They recommended that the adequate intake for
children and adults up to the age of 50 be 200 IU vitamin D/d.
However, adults aged 5070 y and 70 y required 400 and 600

IU vitamin D/d, respectively

Without exposure to sunlight, a
minimum of 1000 IU vitamin D/d is required.
The easiest method of correcting vitamin D deficiency is to
give the patient one pill that contains 50 000 IU vitamin D once
a week for 8 wk (71). This will usually increase the 25(OH)D
concentration to 50 nmol/L (20 ng/mL; Figure 10). If not, the
vitamin D tank may still not be full, and another 8-wk course
of therapy usually corrects the vitamin D deficiency (67; Figure
10). One should suspect a fat-malabsorption problem or poor
compliance if the 25(OH)D concentration does not increase by
25% after these treatments. Exposure to sunlight or a tanning
bed will correct vitamin D deficiency in patients with severe
intestinal fat- malabsorption syndrome (72).

Suplimentare zilnic: data indicate that one g vitamin D3 per kg body weight
per day is able to increase serum 25(OH)D levels by 50 100
nmol/l (20 40 ng/ml) [17, 18, 72]. Given a mean 25(OH)D
level of at least 25 nmol/l (10 ng/ml) in CHF patients (Table
2), a daily vitamin D3 intake of 50-100 g (2,000 4,000
I.U.) would be adequate to achieve a 25(OH)D level above
100 nmol/l (40 ng/ml) in a CHF patient with a body weight
of 75 kg (Table 4). Although these dosages are regarded as
save, serum calcium levels should be checked regularly (at
least every 6 months) in order to exclude the risk of hypercalcemia.
Just as the blood concentration of cholesterol is often
measured on an annual basis, so too should the blood concentration
of 25(OH)D be measured. Indeed, vigilance in maintaining
a healthy 25(OH)D concentration may have more important
health ramifications than a simple lowering of a blood cholesterol
concentration to prevent coronary artery disease. A minimum
concentration of 25(OH)D should be 50 nmol/L, and, for maximum
bone health and prevention of many chronic diseases, the
25(OH)D concentration should be 78100 nmol/L.

A serum 25-hydroxyvitamin D level below50

nmol/l (20 ng/ml) is generally regarded as insufficient.

1. Michael F Holick, Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and
osteoporosis, Am J Clin Nutr 2004;79:36271.
2. Armin Zittermann Stefanie S. Schleithoff
Reiner Koerfer, Vitamin D insufficiency in congestive heart failure:
Why and what to do about it?, Heart Fail Rev (2006) 11:2533
DOI 10.1007/s10741-006-9190-8