Diabetol Metab Syndr 2014 Jan 22;[EPub Ahead of Print], I Miñambres, JL Sánchez-Quesada, J Sánchez-Hernández, J Rodríguez, A de Leiva, A Pérezesearch · February 10, 2014
TAKE-HOME MESSAGE
- In this study looking at 59 patients with familial combined hyperlipidemia (FCHL) and 48 healthy controls, the FCHL patients had significantly lower 25(OH)D concentrations. Treatment with lipid-lowering medication increased 25(OH)D levels in these patients.
- These novel findings suggest that lipid alterations in patients with FCHL may be related to vitamin D deficiency.
Commentary By: David Rakel MD, FAAFP
I suspect that the vitamin D craze will run a course similar to those of vitamins C and E. Initial research suggests everyone should be on it, which yields better research that tempers our enthusiasm. This small study shows two associations: that familial combined hyperlipidemia is associated with low levels of vitamin D and treatment of dyslipidemia is associated with rising levels.
We can also say this for obesity. Those who are overweight have low levels of vitamin D, and when they lose weight, the levels rise. We don’t know the exact mechanisms, but data suggest that vitamin D (more a hormone than a vitamin) is associated with metabolic syndrome and insulin resistance, which often includes dyslipidemia and obesity. When the underlying process is managed with nutrition, weight loss, and exercise, metabolic and hormonal irregularities improve.
Getting vitamin D through sunlight exposure while exercising outside and eating vitamin D–rich foods can be helpful. A supplement may not even be necessary if sufficient amounts of fish and mushrooms are consumed. Tell your patients to leave the mushrooms outside in the sun before eating them. They act in a fashion similar to skin, converting UV light into vitamin D, and, when eaten, provide up to 400 IU a serving. Cooking does not reduce the amount of vitamin D; so, encourage your patients to go ahead and sauté the mushrooms with some caramelized onions and enjoy! Also remember that vitamin D supplementation can be overdone. If you push the serum level > 50 ng/mL, there is a risk of kidney stones. Adding 1000 IU a day of vitamin D3 raises serum levels about 8 to 10 ng/mL.
BACKGROUND
Vitamin D deficiency has been linked to several cardiovascular risk factors but information regarding vitamin D concentrations in familial combined hyperlipidemia (FCHL) is lacking. Our objective was to examine vitamin D concentrations in patients with FCHL and to study the effects of lipid-lowering therapy.
METHODS
We conducted a cross sectional study on 59 patients with FCHL and 48 healthy controls. We analyzed 25-hydroxyvitamin D (25(OH)D) concentrations and their association with lipid parameters, anthropometric measures, C-reactive protein and homeostasis model assessment (HOMA) index. Twenty-three patients with FCHL were also included in a longitudinal study conducted to analyze 25-hydroxyvitamin D concentrations before and after treatment for dyslipidemia.
RESULTS
After adjustment for body mass index and seasonality, patients with FCHL had lower vitamin D concentrations than controls. Adjusted means (standard error of the mean (S.E.M)) for 25(OH)D according to the presence or absence of FCHL were 62.8 (3.6) nmol/L for patients with FCHL and 74.8 (4.1) nmol/L for controls (p = 0.021). In FCHL, hypovitaminosis D was associated with features of atherogenic dyslipidemia. After lipid-lowering therapy, vitamin D concentrations increased (51.0 +/- 31.3 to 58.9 +/- 24.6 nmol/L (P = 0.022)). However, changes in 25(OH)D concentrations did not correlate with changes in other parameters.
CONCLUSIONS
Our findings suggest that FCHL is associated with decreased vitamin D concentrations and that treatment for dyslipidemia improves vitamin D status through an unknown mechanism. Further studies are needed to replicate these data in larger populations and to elucidate the mechanisms involved in this association.