Vitamin D3: Heart Helper - Doctors Prescribing Higher Doses

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Heart Helper:  Inspired by Studies, Doctors Prescribing Higher Doses of Vitamin D

Milwaukee Journal Sentinel -- 12-23-08

Dec. 22 -- It could be a couple of years before formal recommendations are established for taking higher doses of vitamin D as a way to help prevent or treat heart disease, but some doctors aren't waiting.

This month, doctors at Aurora Sinai Medical Center in Milwaukee began giving a mega-dose of 100,000 international units of vitamin D to all patients with chest pains.  After that, they are advised to take 2,000 IU a day, said John Whitcomb, an emergency room physician with the hospital.  Other Aurora hospitals are considering doing the same thing, he said.

Given that the current recommendation for adults is 600 IU a day, that's a considerable departure from the norm, although 2,000 IU a day is considered to be safe for adults.

More and more studies are linking vitamin D deficiency, which is common in large segments of the U.S. population, especially in the winter, to increased risk of heart disease and other ailments.

This month, a review article in the Journal of the American College of Cardiology came to a similar conclusion.  It said heart patients who have insufficient vitamin D levels should be treated with one dose of 50,000 IU a week for eight weeks.  Pills of 50,000 IU generally are available only as a prescription.  After eight weeks, patients can take 50,000 IU every two weeks, or 1,000 to 2,000 IU a day.

The authors recommended vitamin D3, which can be found 'over the counter'.  "Vitamin D supplementation is simple, safe and inexpensive," the authors wrote.

Outdated Guidelines?
James O'Keefe, co-author of the study and a cardiologist at the Mid America Heart Institute in Kansas City, Mo., said, the recommended amounts of vitamin D were established decades ago, when people spent more time outdoors.  Vitamin D is made in the skin when it is exposed to ultraviolet light.  It is difficult to get adequate levels from food sources.

"There is a growing chorus from around the world that the (recommended daily allowance) is way too low," said O'Keefe, who also is a professor of medicine at the University of Missouri-Kansas City.

An inexpensive blood test measures vitamin D levels. Many experts say levels between 21 and 29 nanograms per deciliter are insufficient, and levels less than 21 are deficient.

In Wisconsin, wintertime vitamin D levels appear to be low, according to a research article this year.  The study involved a sample of 71 women ages 70 and older whose vitamin D levels were measured between the winter of 2005 and the spring of 2006 in Madison.  The study found that 59% of the women had vitamin D levels of less than 30 ng/dl.

Several observational studies this year have focused on low levels of the vitamin and increased risk of heart disease:

  • In a study involving 3,258 German heart patients, those in the lowest quarter for vitamin D blood levels had twice the risk of dying, especially from cardiovascular disease, compared with those in the top quarter.

  • Harvard researchers studying 18,225 men found that those with vitamin D levels below 15 ng/dl were 2.4 times more likely to have a heart attack than those with levels above 30 ng/dl.

  • Researchers followed 1,739 members of the Framingham Offspring Study for more than five years and found the rate of cardiovascular disease "events" such as heart attacks, strokes and heart failure was 53% to 80% higher in people with low levels of vitamin D in their blood.

All those studies were observational.  What's needed, experts say, are clinical trials.

Cheapest Medicine?
In the meantime, Whitcomb, of Aurora Sinai, said many doctors in the Aurora health care system will be recommending vitamin D.  He noted that vitamin D is made in the cells of most living organisms.  The vitamin is a hormone that can act on as many as 200 genes.  "This is life's most fundamental hormone," Whitcomb said. "It's the cheapest medicine on the planet."

Indeed, more cardiologists say they are becoming aware of the growing amount of vitamin D research.  One problem, though, is that, while studies consistently link low vitamin D levels to heart disease, there is no consensus on the best way to restore a person's vitamin D levels, said Richard Staudacher, a cardiologist with ProHealth Care Medical Associates Cardiology in Waukesha.

However, because there is little danger from taking vitamin D, Staudacher said he will be testing his patients, and those with low levels probably will be offered doses similar to those recommended in the cardiology journal article.

That would include an initial prescription dose of 50,000 IU and a maintenance dose of about 2,000 IU a day, he said.

A person's vitamin D level "is something all cardiologists should be aware of," Staudacher said.


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