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Low Vitamin D Linked to Coronary Artery Disease in Blacks With HIV

August 2012

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What the Results Mean for You

This study found that vitamin D deficiency -- by itself -- raises the odds of significant coronary artery narrowing in African-American men and women with HIV infection.1 Almost 10% of people in this study group had significant coronary artery narrowing (50% or greater narrowing), even though almost 90% of the group had a low heart disease risk determined by a reliable risk score.

Several well-known risk factors also made significant coronary artery narrowing more likely: male gender, high blood pressure, and high "bad" LDL cholesterol. Using cocaine more than 15 years almost doubled the risk of coronary artery narrowing, and taking antiretrovirals for more than 6 months more than doubled the risk of coronary artery narrowing. That last finding does not mean people should stop taking antiretrovirals or delay starting treatment. Numerous studies, including a large randomized trial,6 show that taking antiretrovirals lowers the overall risk of serious heart disease and other non-AIDS diseases.

This study does not prove that low vitamin D levels cause coronary artery narrowing. Low vitamin D may be a signal of other factors that make heart disease more likely, including poverty, poor health care, and poor health habits like smoking. Almost 85% of people in this study smoked cigarettes, and more than 85% drank alcohol.

Because all study participants were African Americans living in a big city, it is unclear whether the findings apply to other groups in the United States or other countries. African Americans and other people with dark skin have a higher risk of low vitamin D because their skin blocks the sun rays that help make vitamin D in the body. However, several other recent studies found high rates of vitamin D deficiency in other HIVpositive groups in the United States and elsewhere.7-10 And these findings add to other evidence suggesting that low vitamin D may raise the risk of coronary artery disease.4,11,12 (See "People with a high risk of low vitamin D" for more information on risk factors.)


People With a High Risk of Low Vitamin D
  • Older adults
  • People with limited sun exposure
  • People with dark skin
  • People who absorb fat poorly
  • People who are obese or who have had gastric bypass surgery
  • Breastfed infants

Source: Office of Dietary Supplements. National Institutes of Health. Dietary supplement factsheet: vitamin D.


Vitamin D is necessary for bone health, for muscle function, and for a healthy immune system.13 Getting as little as 10 minutes of sun exposure daily may help prevent vitamin D deficiency.14 Few foods contain high amounts of vitamin D. Those that do include cod liver oil, swordfish, salmon, tuna, and vitamin D-fortified orange juice, milk, and yoghurt. For a full list of foods rich in vitamin D, use the link at reference 13 below.

The U.S. National Institutes of Health says some people may need vitamin D supplements to maintain healthy levels.13 Your healthcare provider can help determine whether you need vitamin D supplements by measuring your vitamin D level and reviewing your risk for low vitamin D.

For more information on vitamin D, see the National Institutes of Health Fact Sheet linked at reference 15 below. It is also very important for people with HIV to address other heart risk factors like those found in this study (high blood pressure, high LDL cholesterol, and cocaine use) and those established by other research (such as smoking, overweight, obesity, diabetes, and physical inactivity). These are all problems that can be prevented or treated with the help of your HIV provider.


References

  1. Lai H, Gerstenblith G, Fishman EK, et al. Vitamin D deficiency is associated with silent coronary artery disease in cardiovascularly asymptomatic African Americans with HIV infection. Clin Infect Dis. 2012;54:1747-1755.
  2. Camargo CA Jr. Vitamin D and cardiovascular disease: time for large randomized trials. J Am Coll Cardiol. 2011;58:1442-1444.
  3. Lee JH, O'Keefe JH, Bell D, Hensrud DD, Holick MF. Vitamin D deficiency: an important, common, and easily treatable cardiovascular risk factor? J Am Coll Cardiol. 2008;52:1949-1956.
  4. Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008;117:503-511.
  5. Lai H, Fishman E, Gerstenblith G, et al. Vitamin D deficiency is associated with significant coronary stenoses in asymptomatic African American chronic cocaine users. Int J Cardiol. 2012; 158:211-216.
  6. Strategies for Management of Antiretroviral Therapy (SMART) Study Group, El-Sadr WM, Lundgren JD, Neaton JD, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355:2283-2296.
  7. Allavena C, Delpierre C, Cuzin L, et al. High frequency of vitamin D deficiency in HIV-infected patients: effects of HIV-related factors and antiretroviral drugs. J Antimicrob Chemother. 2012 May 15. Epub ahead of print.
  8. Adeyemi OM, Agniel D, French AL, et al. Vitamin D deficiency in HIV-infected and HIV-uninfected women in the United States. J Acquir Immune Defic Syndr. 2011;57:197-204.
  9. Cervero M, Agud JL, García-Lacalle C, et al. Prevalence of vitamin D deficiency and its related risk factor in a Spanish cohort of adult HIV-infected patients: effects of antiretroviral therapy. AIDS Res Hum Retroviruses. 2012 Mar 6. Epub ahead of print.
  10. Crutchley RD, Gathe J Jr, Mayberry C, Trieu A, Abughosh S, Garey KW. Risk factors for vitamin D deficiency in HIV-infected patients in the south central United States. AIDS Res Hum Retroviruses. 2012;28:454-459.
  11. Gelfand JM, Cree BA, McElroy J, et al. Vitamin D in African Americans with multiple sclerosis. Neurology. 2011;76:1824-1830.
  12. Kendrick J, Targher G, Smits G, Chonchol M. 25-Hydroxy vitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey. Atherosclerosis. 2009;205:255-260.
  13. Office of Dietary Supplements. National Institutes of Health. Dietary supplement fact sheet: vitamin D.
  14. Mayo Clinic Health Information. Vitamin D.
  15. Office of Dietary Supplements. National Institutes of Health. Dietary supplement fact sheet.
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This article was provided by The Center for AIDS Information & Advocacy. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.
 

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