Sun deprivation, vitamin D insufficiency, coronary heart disease, and diabetes mellitus: A point of concern

This review summarises available evidence for an association of low vitamin D status with chronic diseases, such as cardiovascular disease (CVD), congestive heart failure (CHF), and diabetes mellitus. Human vitamin D status primarily depends on skin exposure to the ultraviolet B (UVB) spectrum of the sunlight. Sun-deprived lifestyle is associated with low vitamin D status and high morbidity for CVD and diabetes mellitus. Experimental data have demonstrated the essential role of the vitamin D hormone calcitriol for vascular health and insulin secretion. Several retrospective studies already indicate that calcitriol and other active vitamin D analogues reduce all-cause and cardiovascular mortality in specific patients groups. In addition, vitamin D status is low in groups with a high cardiovascular morbidity risk such as elderly people and immobilized subjects. Meanwhile, the first large observational studies indicate an association between low vitamin D status and an increased risk for CVD and type 2 diabetes in the general population. CVD is also a major risk factor for CHF. Up to 50% of end-stage CHF patients have very low calcitriol concentrations. In these patients, calcitriol is an independent predictor of survival. Importantly, there is evidence that CHF patients and healthy subjects differ during earlier periods of their lives with regard to life style factors that are associated with risk of a low vitamin D status. Available data point to the importance of preventive strategies to improve vitamin D status in early periods of life. Such strategies should