Vitamin D vs. Cholesterol

Vitamin D vs Lowering Cholesterol to Prevent Heart Failure

It is not unusual for me to hear from patients that they are thrilled to see their total cholesterol, or that of their loved ones go down. Apparently, not only are some of my patients thrilled, but apparently the MD’s are thrilled as well. The only one unimpressed is me.

I want to say “Big Deal”, but with sarcasm. Decreasing one’s cholesterol levels has ridiculously little effect on health. One certainly won’t feel any better. Though many people consider it miraculous that some herbal mix will lower their cholesterol from 225 to below 200, it’s not a big deal. Overall risk of having a heart attack might decrease by only a few percentage points, perhaps a 2% decrease in risk.”

There is a new paper, posted online August 5 and is scheduled for publication in the Journal of Clinical Endocrinology and Metabolism. Stefan Pilz and his colleagues at the Department of Public Health, Social and Preventative Medicine at the University of Heidelberg in Germany, looked for associations between vitamin D deficiency, heart failure and sudden cardiac death. Sudden cardiac death is medical language for dropping dead of a heart attack.

The researchers followed 3,316 people for a period of almost 8 years and tracked their vitamin D levels and tracked who died of heart problems. Over the course of the study 116 people died of heart failure and 188 of heart attacks. There was a clear inverse association between vitamin D and dying. After adjusting for other cardiovascular risk factors they were able to calculate hazard ratios for different levels of vitamin D. Patients with severe deficiency, defined as less than 10ng/ml on the 25(OH)D test had risk ratios of 2.8 for heart failure and 5.05 for sudden cardiac death when compared with people with vitamin D levels > 30 ng/ml. This means the people deficient in D were about three times as likely to die of heart failure and five times as likely to die of heart attacks than people with what we consider OK levels.

This is huge. Lowering someone’s cholesterol from 230 to below 200 may possibly reduce a man’s risk of sudden cardiac death by 2%. Last time I looked there was no data to show that it has any protective benefit in women. On the other hand, increasing someone’s vitamin D level from below 10 to above 30 reduces risk by a factor of 5. Think 500% difference.

How common is it to be this deficient? We often see patients in our practice close to this low, below 20 is not rare. Dr Sunny Linnebur (I kid you not, that is her name) of the University of Colorado is our best source of information about prevalence of vitamin D deficiency in Denver. In March of 2007 the American Journal of Pharmacotherapy published her research on vitamin D levels in the elderly in Denver. She defined vitamin D deficiency as below 32 ng/ml, a level that is generally accepted as the cutoff to what is acceptable. Collecting data on 80 older people, average age almost 79, she found that 59 of them (74%) were deficient.

Testing for vitamin D deficiency doesn’t cost much more than testing for cholesterol. Low levels of vitamin D, enough to increase cardiovascular disease risk are as common, if not more so, than elevated cholesterol. From these numbers it would appear that correcting vitamin D deficiency would have a greater impact on morbidity and mortality than correcting cholesterol. If we are to believe these numbers, a 2% versus 500% decrease in sudden cardiac death.

What’s the problem then? The only explanation I can see for the disparity of attention given to vitamin D versus cholesterol is the profit. Treating cholesterol requires regular use of expensive patented drugs. Correcting vitamin D deficiency requires more sun exposure or if profoundly deficient, inexpensive vitamin supplements.

The drugs used to lower cholesterol come with side effects. The most common is leg pain with walking. The worse case scenario is that this leg pain progresses to rhabdomylolysis, rather than pain, the actual destruction of the muscle. Current medical literature does not report side effects from supplementing with vitamin D. Of course there are other benefits that we have mentioned elsewhere.

The full text of this study can be downloaded for free at: http://jcem.endojournals.org/cgi/rapidpdf/jc.2008-0784v1 http://denvernaturopathic.com/DversusCholeserolandCVD.html

I wrote about this cholesterol business last summer after reading Overdosed America and meeting the author, John Abramson: http://denvernaturopathic.com/OverdosedAmerica.htm

A nice and easy to read article on Vitamin D appeared in the Globe and Mail earlier this year: http://www.theglobeandmail.com/servlet/story/RTGAM.20080308.wxvitamin08/BNStory/special ScienceandHealth/home


 

References

Pilz S et al, “Association of Vitamin D Deficiency with Heart Failur and Sudden Cardiac Death,” J Clin Endocrinol Metab. 2008 Aug 5.