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failure in a small group of patients admitted for treatment and in free-living controls. The study found a significant difference in biomarker levels between treated patients compared with controls for both 25OHD and calcitriol levels.

One small case–control study was identified that determined the relationship between serum 25OHD levels and risk for myocardial infarction in at-risk patients compared with normal controls. In this study, Scragg et al. (1990) found that serum 25OHD levels were significantly lower in myocardial infarction cases than in controls and that the difference was greater (but not significantly so) during the winter.

Although these studies together provide evidence for lower serum 25OHD levels in individuals with CVD, whether the low serum 25OHD levels are sufficient to predict risk for CVD has not been clearly established. Additional evidence indicates that low serum 25OHD levels are associated with risk factors for CVD—specifically, increased carotid arterial thickness (Targher et al., 2006)—and apparent CVD in patients with type 2 diabetes (Cigolini et al., 2006; Chonchol et al., 2008). Additionally, some studies suggest a positive association between vitamin D intake and CVD risk factors associated with other chronic conditions, including hypertension (Krause et al., 1998; Pfeifer et al., 2001; Forman et al., 2007; L. Wang et al., 2008; Wang et al., 2010), impaired glucose tolerance or type 2 diabetes (Liu et al., 2005; Pittas et al., 2006, 2007a; Mattila et al., 2007), and inflammation (Timms et al., 2002; Schleithoff et al., 2006; Shea et al., 2008).

Risk of incident hypertension in relation to dietary vitamin D intake has been evaluated in three large prospective study cohorts; NHS 1, NHS 2, and the HPFS for 8 years and longer. Women in NHS 1 and NHS 2 (a younger cohort) showed no association between vitamin D intake and risk for incident hypertension. Likewise, among men from the HPFS no association was found between vitamin D intake and risk for incident hypertension. Al-Delaimy et al. (2003) also found no association between calcium intake, vitamin D intake, or total dairy intake and risk for total ischemic heart disease in men enrolled in the HPFS. Similarly, no association was found when the cohort was analyzed for calcium supplement intake, although an inverse association was identified between calcium intake among supplement users compared with nonusers and fatal ischemic heart disease only.

In contrast to the intake studies, in a prospective study, Forman et al. (2007) found inverse associations between incidence of hypertension and measured serum 25OHD levels in a larger cohort in the HPFS and in women from a larger cohort in NHS.

In summary, three of four large, prospective cohort studies reviewed found associations between serum 25OHD levels and risk for CVD. Among the many smaller observational studies of lower quality that were identified,



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