Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis
Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis
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DOI：
10.1001/jamacardio.2019.1870
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发表时间：
2019-08-01
期刊：
影响因子：
24
通讯作者：
Manson, JoAnn E.
中科院分区：
文献类型：
--
作者：
Barbarawi, Mahmoud;Kheiri, Babikir;Manson, JoAnn E.
关键点补充维生素D与心血管疾病风险有任何关联吗？结果在这项包含超过83000名参与者的随机临床试验的荟萃分析中，与安慰剂相比，维生素D补充剂与主要不良心血管事件、心肌梗死、中风、心血管疾病死亡率或全因死亡率的风险降低无关。这些结果表明，维生素D补充剂可能不提供心血管保护，可能不适用于此目的。这项荟萃分析的21个随机临床试验研究的作用，维生素D补充剂在减少心血管事件和全因死亡率。重要性观察性研究报告之间的联系低血清维生素D水平和心血管疾病（CVD）事件的风险增加，但这些研究无法证明因果关系，因为可能存在无法测量的混杂因素。目的我们对随机临床试验进行了荟萃分析，测试维生素D补充与减少心血管事件和全因死亡率的相关性。数据来源通过PubMed、科克伦图书馆和Embase进行的文献检索由2名审查员完成，从每个数据库成立到2018年12月15日。研究选择纳入标准是随机临床试验，报告长期（>= 1年）补充维生素D对CVD事件和全因死亡率的影响。排除不包括心血管结局的研究。数据提取和合成数据由2位作者独立提取。使用随机效应模型报告风险比（RR）和95% CI。主要结局和指标主要不良心血管事件是主要结局，心肌梗死、卒中或脑血管意外、CVD死亡率和全因死亡率是次要终点。结果共纳入21个随机临床试验（83291例患者，其中41669例接受维生素D治疗，41622例接受安慰剂治疗）。试验参与者的平均（SD）年龄为65.8（8.4）岁; 61943（74.4%）例为女性。只有4项试验将CVD预先指定为主要终点。与安慰剂相比，补充维生素D与减少主要不良心血管事件无关（RR，1.00 [95% CI，0.95-1.06]; P= 0.85），也不是心肌梗死的次要终点（RR，1.00 [95% CI，0.93-1.08]; P=.92），卒中（RR，1.06 [95% CI，0.98-1.15]; P= 0.16），CVD死亡率（RR，0.98 [95% CI，0.90-1.07]; P= 0.68）或全因死亡率（RR，0.97 [95% CI，0.93-1.02]; P= 0.23）。按性别、基线25-羟基维生素D水平、维生素D剂量、制剂（每日与推注给药）以及是否同时给予钙，结果通常一致。结论和相关性在这项更新的荟萃分析中，维生素D补充与主要不良心血管事件、个体CVD终点（心肌梗死、卒中、CVD死亡率）或全因死亡率的降低无关。研究结果表明，维生素D补充剂不能提供心血管保护，也不适用于此目的。
Key PointsQuestionDoes vitamin D supplementation have any association with cardiovascular disease risk? FindingsIn this meta-analysis of randomized clinical trials that included more than 83000 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. MeaningThese results suggest that vitamin D supplementation may not confer cardiovascular protection and may not be indicated for this purpose.This meta-analysis of 21 randomized clinical trials examines the role of vitamin D supplementation in reducing cardiovascular events and all-cause mortality.ImportanceObservational 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. ObjectiveWe 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 SourcesLiterature search through PubMed, the Cochrane Library, and Embase was completed by 2 reviewers from each database's inception to December 15, 2018. Study SelectionInclusion 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 SynthesisData were abstracted independently by 2 authors. Random-effects models were used to report the risk ratios (RRs) and 95% CIs. Main Outcomes and MeasuresMajor 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. ResultsTwenty-one randomized clinical trials were included (including 83291 patients, of whom 41669 received vitamin D and 41622 received placebos). The mean (SD) age of trial participants was 65.8 (8.4) years; 61943 (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 RelevanceIn 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.