Monday, August 02, 2010

Vitamin D and Arterial Pulse Wave Velocity

Ok, so here is a study that continues the discussion of vitamin D supplementation to enhance health (or a surrogate of health). In this randomized trial, authors took 49 Black teens with mean age of 16.3 years and gave one group 2000 IU of vitamin D while control group was given 400 IU daily. Investigators measured carotid-femoral pulse-wave velocity (PWV) before and after 16 weeks of therapy in both groups. Investigators noticed a significant decrease in PWV in subjects taking higher dose of vitamin D (experimental group) as compared to the control group (group that was given 400 IU/day). In fact, in the control group PWV increased during the 16 week period.

This was despite the fact that both groups received vitamin D. To be sure that oral vitamin D was enough to raise serum vitamin D levels, investigators checked serum levels of vitamin D. Interestingly, serum levels increased in both groups.

Let’s see experimental group first (in nmol/L):
Baseline: 33.1
4 weeks: 55.0
8 weeks: 70.9
16 weeks: 85.7

Now PWV at baseline in the experimental group was
Baseline: 5.41 m/s
16 weeks: 5.33 m/s
p-value: 0.03

Ok, so this is relatively straightforward story so far, vitamin D was given, serum levels increased, and there was decrease in PWV. But lets see what happens with the control group; serum vitamin D levels were as below (in nmol/L):
Baseline: 34
4 weeks: 44.9
8 weeks: 51.2
16 weeks: 59.8

There is a rise in vitamin levels although not as pronounced as with 2000 IU but there is a considerable increase which is statistically significant as well. Now, if vitamin D is really effective then there should be some decrease in PWV although it might not be as much as with the high dose group, right? Lets see what was the PWV in the control group:
Baseline: 5.38 m/s
16 weeks: 5.71 m/s
p-value: 0.02

Oops! There is an increase in PWV and this is despite the fact that the serum levels of vitamin D almost doubled. In other words, this group was better off without any vitamin D supplementation. Hum! How can we interpret these findings? Is it possible that there is a cut-off after which vitamin D is effective? We know that is not the case; there is no consensus about what is the optimum level of vitamin D but it is much closer to 35 than to 60 and certainly not 80 nmol/L. Is it possible that very high vitamin D acts differently? Or is it possible that this is simply a result that happened by chance alone, that because the effect was in the correct direction and that it was consistent with the currently accepted wisdom. We don’t know but this is likely as the sample size was small. It is possible that blinding was not adequate enough and an investigator with a belief that vitamin D is effective may have interpreted PWV studies differently. We don’t know and while we don't know it is difficult to understand these results.

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