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Is D deficiency a risk factor for peripheral artery disease?

Posted on: October 31, 2012   by  John Cannell, MD

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Peripheral artery disease (PAD) is atherosclerotic lesions of arteries other than the heart or brain, like in the legs. It affects 4% of the general population above age 40 and 15% of those over the age of 55. Known risk factors include diabetes, smoking, hypertension, hyperlipidemia, black race, and elevated CRP and homocysteine levels. By the way, it is important to know that vitamin D directly upregulates the enzyme that gets rid of homocysteine.

Kriebitzsch C, Verlinden L, Eelen G, van Schoor NM, Swart K, Lips P, Meyer MB, Pike JW, Boonen S, Carlberg C, Vitvitsky V, Bouillon R, Banerjee R, Verstuyf A. 1,25-dihydroxyvitamin D3 influences cellular homocysteine levels in murine preosteoblastic MC3T3-E1 cells by direct regulation of cystathionine β-synthase. J Bone Miner Res. 2011 Dec;26(12):2991-3000.

PAD is associated with cardiovascular disease, all-cause mortality, coronary heart disease, and stoke, independent of traditional risk factors. PAD is often diagnosed with an ultrasound of an artery in your ankle. Dr Gouveri and colleagues from Aristotle University of Thessaloniki  wrote an excellent paper about PAD and vitamin D, reviewing the evidence that vitamin D deficiency is yet another risk factor for PAD.

Gouveri E, Papanas N, Hatzitolios AI, Maltezos E. Hypovitaminosis D and peripheral arterial disease: Emerging link beyond cardiovascular risk factors. Eur J Intern Med. 2012 Jul 24. [Epub ahead of print]

They discussed several studies:

  1. A large population (NHANES 2001-2004) study showed a strong negative correlation between PAD and vitamin D levels.
  2. Multiple similar studies have shown the same thing.
  3. For each 10 ng/ml lower your vitamin D, the risk of PAD went up by 13 %.
  4. 8.5% of older black adults have PAD compared to 5.3% of older Whites.
  5. Patients with severe PAD are more likely to have lower vitamin D levels than do patients with mild disease.
  6. PAD patients often have trouble walking, so they stay inside setting up a viscous cycle of immobility and sunlight deficiency.
  7. In PAD patients, amputation is higher among those with the lowest 25(OH)D levels.
  8. Vitamin D decreases the inflammatory cytokines (TNF and IL-6) and increases the anti-inflammatory cytokine (IL-10) associated with PAD.
  9. Vitamin D regulates multiple genes involved in maintenance of the wall and inner lining of arteries.

The authors conclude, “Combining outdoor activity with sun exposure emerges as a challenging practice that might help prevent vitamin D deficiency and PAD,” They add that until randomized controlled trials show that supplements help prevent or treat PAD, “sun exposure is the recommended lifestyle practice to prevent both PAD and hypovitaminosis D.”

Peripheral artery disease (PAD) is atherosclerotic lesions of arteries other than the heart or brain, like in the legs.

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