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(Circulation. 2008;118:1476-1485.)
© 2008 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

The "Sunshine Deficit" and Cardiovascular Disease

Diane E. Wallis, MD; Sue Penckofer, RN, PhD; Glen W. Sizemore, MD

From Midwest Heart Specialists, Downers Grove, Ill (D.E.W.); School of Nursing, Loyola University Chicago, Maywood, Ill (S.P.); and Department of Medicine, Division of Endocrinology and Metabolism, Loyola University of Chicago Stritch School of Medicine, Maywood, Ill (G.W.S.).

Correspondence to Diane E. Wallis, MD, FACC, Midwest Heart Specialists, 3825 Highland Ave, Downers Grove, IL 60515. E-mail dwallis@midwestheart.com

Key Words: calcium • heart diseases • hyperparathyroidism • nutrition • vitamin D deficiency

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In past decades, the primary focus on vitamin D was the recognition and treatment of deficiency as it related to metabolic bone disease (rickets, osteomalacia, and secondary hyperparathyroidism). In the last 10 years, however, with the discovery of vitamin D receptors in multiple tissue types has come the recognition that the role of vitamin D extends beyond the musculoskeletal system.¹ The presence of abundant vitamin D receptors in myocardial tissue and vasculature and the observation that hypertension may be ameliorated with vitamin D suggest a greater role for vitamin D in the cardiovascular system.² Presently, large numbers of people are found to have hypovitaminosis D (a term chosen for this review to indicate any concentration below normal under substrate-saturated conditions) resulting in part from more indoor activities and the purposeful avoidance of sunshine. This review first describes why vitamin D, parathyroid hormone (PTH), and the skeleton are important to the heart and vasculature, then outlines why the epidemic of hypovitaminosis D deserves further scrutiny by the cardiovascular community, and finally suggests why treatment options for reducing hypovitaminosis D may favorably affect the morbidity and mortality of common cardiovascular disorders.

	Vitamin D and PTH: Basic Biochemistry and Physiology

 
Vitamin D is both a nutrient and a hormone. It is an essential precursor of calcitriol, 1,25-hydroxyvitamin D3 [1,25(OH)₂D], which is necessary for bone development, growth, and mineralization and the maintenance of skeletal integrity. A cascade of steps is needed to cause progression of lesser active nutritionally ingested or synthesized vitamin D to more biologically active forms as depicted in . . . [Full Text of this Article]