高血压与维生素D.ppt
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1、高血压与维生素 D,新疆医科大学第一附属医院心脏中心高血压科 徐新娟,大量的流行病学研究发现,维生素D不足现象普遍存在。多数专家认为血清25(OH)D 20g/L为缺乏;2030g/L为不足;30g/L为充足。 据估计维生素D缺乏或不足可影响世界范围内约50%人口,全球有近10亿人维生素D缺乏或不足。 国内研究发现我国中老年人群维生素D 缺乏和不足发生率分别为69.2%和24.4%, 而维生素D充足的个体仅占6.4%。,研究背景,www.bio-,Vitamin D has long been known to be important for bone health,Cholecalcife
2、rol(D3) Ergocalciferol(D2),www.bio-,Synthesis and Metabolism of Vitamin D,1,25二羟维生素D3与其维生素D受体结合形成激素-受体复合物,再与细胞核的维生素D反应元件相结合,激活或抑制含有维生素D反应元件的基因约200,从而发挥其生物学作用。,Prevalence of insufficient 25(OH)D levels(30ng/ml) by sex and race/ethnicity across age groups: Third National Health and Nutrition Examinati
3、on Survey,41% of men and 53% of women in US have insufficient levels. Prevalence of insuficient vitamin D levels increase with age,维生素D,年龄,纬度,季节,肥胖,性别,摄入含维生 素D的食物,防晒霜,种族,Risk factors for Vitamin D deficiency, Darker skin coloring (increased melanin blocks UVB synthesis of vit D) Living in Northern H
4、emisphere(greater distance from equator) - for those living above 35 degrees latitude, little or no vitamin D can be produced from November to February Lower altitude, more cloud covering, sunscreen, covered manner of dress Winter season Obesity (fat cells sequester vitamin D) Malabsorption syndrome
5、s Older age (decreased absorption from diet, decreased production from skin) Kidney disease (cant make activated form),www.bio-,CHD death rates are higer in countries of increased geographic latitudes where average serum vitamin D are lowest,www.bio-,Institute of Medicine Recommendations, 1997 recom
6、mended daily allowance 200 IU/day for ages 1-50 400 IU/day for ages 51-70 600 IU/day for those 70 years Maximum daily allowance 2000 IU/day 2010 recommended daily allowance 600 IU/day for ages 1-70 800 IU/day for those 71 Maximum daily allowance 4000 IU/day 2010 update: Blood levels 20 ng/ml are pro
7、bably adequate,www.bio-,What about toxicity?, Rare, resulting mostly from acutehypercalcemia Typically from doses 10,000 IU per day with associated 25(OH)D levels 150 ng/ml Observational data suggests 25(OH)D levels 60 ng/ml were associated with increased risk of pancreatic cancer, vascular calcific
8、ation, and death,Age-, Sex-,and Race-Adjusted ORs of Select CVD Risk Factors Between the First and Fourth Quartiles of Serum 25(OH)D Levels (cross-sectional data from NHANES-),Martins,D. et al. Arch Intern Med 2007;167:1159-1165,Vitamin D levels and risk of CVD events: Framingham offspring prospecti
9、ve cohort study,Mean age 59 y,55% women , all Caucasian,Wang TJ et al. Circulation 2008;117:503-511.,Mortality Rate Ratios of All-Cause Mortality for 13,331 adults 20y followed for median 9 year by 25(OH)D Quartiles:NHANES- linked mortality files,*Limited Model adjusted for age, sex, race, and seaso
10、n *Fully-Adjusted Model includes age, sex, race, season, HTN, history of prior CVD, Diabetes mellitus, smoking, HDL cholesterol,total cholesterol medications, eGFR, albumin, log(albumin-creatinine ratio),log(CRP), BMI, physical activity, vitamin D supplementation and low SES.,25(OH)D deficiency pred
11、icts risk of incident hypertension,Measured Plasma 25(OH)D and 4-Year Multivariable Adjusted Relative Risk of Incident Hypertension in Men and Women,Multivariable models adjusted for age ,BMI,physical activity(all as continuous variables),as well as race, and(in women) menopausal status.,613 Men fro
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