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Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies.
BMJ 2014; 348:g1903BMJ

Abstract

OBJECTIVE

To evaluate the extent to which circulating biomarker and supplements of vitamin D are associated with mortality from cardiovascular, cancer, or other conditions, under various circumstances.

DESIGN

Systematic review and meta-analysis of observational studies and randomised controlled trials.

DATA SOURCES

Medline, Embase, Cochrane Library, and reference lists of relevant studies to August 2013; correspondance with investigators.

STUDY SELECTION

Observational cohort studies and randomised controlled trials in adults, which reported associations between vitamin D (measured as circulating 25-hydroxyvitamin D concentration or vitamin D supplement given singly) and cause specific mortality outcomes.

DATA EXTRACTION

Data were extracted by two independent investigators, and a consensus was reached with involvement of a third. Study specific relative risks from 73 cohort studies (849,412 participants) and 22 randomised controlled trials (vitamin D given alone versus placebo or no treatment; 30,716 participants) were meta-analysed using random effects models and were grouped by study and population characteristics.

RESULTS

In the primary prevention observational studies, comparing bottom versus top thirds of baseline circulating 25-hydroxyvitamin D distribution, pooled relative risks were 1.35 (95% confidence interval 1.13 to 1.61) for death from cardiovascular disease, 1.14 (1.01 to 1.29) for death from cancer, 1.30 (1.07 to 1.59) for non-vascular, non-cancer death, and 1.35 (1.22 to 1.49) for all cause mortality. Subgroup analyses in the observational studies indicated that risk of mortality was significantly higher in studies with lower baseline use of vitamin D supplements. In randomised controlled trials, relative risks for all cause mortality were 0.89 (0.80 to 0.99) for vitamin D3 supplementation and 1.04 (0.97 to 1.11) for vitamin D2 supplementation. The effects observed for vitamin D3 supplementation remained unchanged when grouped by various characteristics. However, for vitamin D2 supplementation, increased risks of mortality were observed in studies with lower intervention doses and shorter average intervention periods.

CONCLUSIONS

Evidence from observational studies indicates inverse associations of circulating 25-hydroxyvitamin D with risks of death due to cardiovascular disease, cancer, and other causes. Supplementation with vitamin D3 significantly reduces overall mortality among older adults; however, before any widespread supplementation, further investigations will be required to establish the optimal dose and duration and whether vitamin D3 and D2 have different effects on mortality risk.

Authors+Show Affiliations

Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

24690623

Citation

Chowdhury, Rajiv, et al. "Vitamin D and Risk of Cause Specific Death: Systematic Review and Meta-analysis of Observational Cohort and Randomised Intervention Studies." BMJ (Clinical Research Ed.), vol. 348, 2014, pp. g1903.
Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.
Chowdhury, R., Kunutsor, S., Vitezova, A., Oliver-Williams, C., Chowdhury, S., Kiefte-de-Jong, J. C., ... Franco, O. H. (2014). Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ (Clinical Research Ed.), 348, pp. g1903. doi:10.1136/bmj.g1903.
Chowdhury R, et al. Vitamin D and Risk of Cause Specific Death: Systematic Review and Meta-analysis of Observational Cohort and Randomised Intervention Studies. BMJ. 2014 Apr 1;348:g1903. PubMed PMID: 24690623.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. AU - Chowdhury,Rajiv, AU - Kunutsor,Setor, AU - Vitezova,Anna, AU - Oliver-Williams,Clare, AU - Chowdhury,Susmita, AU - Kiefte-de-Jong,Jessica C, AU - Khan,Hassan, AU - Baena,Cristina P, AU - Prabhakaran,Dorairaj, AU - Hoshen,Moshe B, AU - Feldman,Becca S, AU - Pan,An, AU - Johnson,Laura, AU - Crowe,Francesca, AU - Hu,Frank B, AU - Franco,Oscar H, Y1 - 2014/04/01/ PY - 2014/4/3/entrez PY - 2014/4/3/pubmed PY - 2014/7/6/medline SP - g1903 EP - g1903 JF - BMJ (Clinical research ed.) JO - BMJ VL - 348 N2 - OBJECTIVE: To evaluate the extent to which circulating biomarker and supplements of vitamin D are associated with mortality from cardiovascular, cancer, or other conditions, under various circumstances. DESIGN: Systematic review and meta-analysis of observational studies and randomised controlled trials. DATA SOURCES: Medline, Embase, Cochrane Library, and reference lists of relevant studies to August 2013; correspondance with investigators. STUDY SELECTION: Observational cohort studies and randomised controlled trials in adults, which reported associations between vitamin D (measured as circulating 25-hydroxyvitamin D concentration or vitamin D supplement given singly) and cause specific mortality outcomes. DATA EXTRACTION: Data were extracted by two independent investigators, and a consensus was reached with involvement of a third. Study specific relative risks from 73 cohort studies (849,412 participants) and 22 randomised controlled trials (vitamin D given alone versus placebo or no treatment; 30,716 participants) were meta-analysed using random effects models and were grouped by study and population characteristics. RESULTS: In the primary prevention observational studies, comparing bottom versus top thirds of baseline circulating 25-hydroxyvitamin D distribution, pooled relative risks were 1.35 (95% confidence interval 1.13 to 1.61) for death from cardiovascular disease, 1.14 (1.01 to 1.29) for death from cancer, 1.30 (1.07 to 1.59) for non-vascular, non-cancer death, and 1.35 (1.22 to 1.49) for all cause mortality. Subgroup analyses in the observational studies indicated that risk of mortality was significantly higher in studies with lower baseline use of vitamin D supplements. In randomised controlled trials, relative risks for all cause mortality were 0.89 (0.80 to 0.99) for vitamin D3 supplementation and 1.04 (0.97 to 1.11) for vitamin D2 supplementation. The effects observed for vitamin D3 supplementation remained unchanged when grouped by various characteristics. However, for vitamin D2 supplementation, increased risks of mortality were observed in studies with lower intervention doses and shorter average intervention periods. CONCLUSIONS: Evidence from observational studies indicates inverse associations of circulating 25-hydroxyvitamin D with risks of death due to cardiovascular disease, cancer, and other causes. Supplementation with vitamin D3 significantly reduces overall mortality among older adults; however, before any widespread supplementation, further investigations will be required to establish the optimal dose and duration and whether vitamin D3 and D2 have different effects on mortality risk. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/24690623/Vitamin_D_and_risk_of_cause_specific_death:_systematic_review_and_meta_analysis_of_observational_cohort_and_randomised_intervention_studies_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=24690623 DB - PRIME DP - Unbound Medicine ER -