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Curr Cardiovasc Risk Rep. 2017 Jan;11(1). pii: 3. doi: 10.1007/s12170-017-0528-7. Epub 2017 Jan 21.

Vitamin D and Cardiovascular Disease: Can Novel Measures of Vitamin D Status Improve Risk Prediction and Address the Vitamin D Racial Paradox?

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Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.



To provide a state-of-the-art update on some emerging measures of vitamin D status and discuss how assessment of these key vitamin D metabolites might improve prognostication of risk for cardiovascular disease (CVD) outcomes.


Vitamin D deficiency is a highly prevalent condition and relatively easy to treat with supplementation and/or modest sunlight exposure. A substantial body of experimental and epidemiological evidence suggest that vitamin D deficiency is a risk factor for CVD. Most epidemiologic studies to date have focused on total 25-hydroxyvitamin D [25(OH)D] concentrations, which is the established marker of vitamin D stores. However, there is emerging evidence that other novel markers of vitamin D metabolism may better characterize 'true' vitamin D status. Some key novel measures include bioavailable 25(OH)D, free 25(OH)D, 1-25 dihydroxyvitamin D, 24,25-dihydroxyvitamin D3 [24,25(OH)2D3], and ratio of 24,25(OH)2D3 to 25(OH)D [the vitamin D metabolic ratio]. Utilization of these biomarkers may enhance understanding of the association between vitamin D and CVD risk, and may provide explanation for the observation that 25(OH)D is a stronger CVD risk factor in whites than blacks.


Novel measures of vitamin D status could potentially change clinical practice regarding how patients are currently screened for vitamin D status and defined as vitamin D deficient or not. However, whether measuring any of these alternate markers of vitamin D status can provide further insight regarding CVD risk beyond the traditionally measured 25(OH)D concentrations is uncertain at this time. This is an area where further research is strongly needed.


Biomarker; Cardiovascular Risk Factor; Vitamin D

Conflict of interest statement

CONFLICTS OF INTEREST Dr. Michos has no conflicts related to this topic. Unrelated to this work, she has been a consultant (modest) for Siemens Healthcare Diagnostics No other authors declare a conflict of interest.

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