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ask the expert In 1981, Professor Robert Scragg ���rst hypothesized that vitamin D de���ciency contributed to heart disease. He used latitudinal, seasonal and altitudinal data to support his theory. Thirty-two years later, we are getting closer to understanding how much truth there is to his theory. Recently, Dr. Peter Brondum-Jacobsen and colleagues from the Copenhagen University Hospital in Denmark studied more than 10,000 men and women, pooling from people that had a vitamin D level drawn in the early 1980s and following the patients for 29 years to see who developed heart disease, a heart attack or died. Remember, this was likely mostly sun-derived vitamin D. It remains an open question if vitamin D supplements will achieve the same effect, although the basic science of how vitamin D works in the cardiovascular system make it likely that supplementation studies using an adequate dose will prove vitamin D to be bene���cial. Keep your 25(OH)D level at about 50 ng/ml and remember that the sun is your friend. The average vitamin D level of these patients was 19 ng/ml. The authors found that patients with the lowest vitamin D levels had a 72 percent increased risk for heart disease, a 99 percent increased risk of heart attack, and 88 percent increased risk of early death, and a 122 percent increased risk for fatal heart attack, compared to those with higher levels. After correcting for confounders ��� factors such as obesity and age that may have obscured the strength of the corrected results ��� the results remained strong. The researchers then conducted a meta-analysis, gathering 18 general population studies, including their own, totaling more than 82,000 people. The studies used various de���nitions of inadequacy. They found the risk of early death of people with ���inadequate levels��� was 46 percent greater than those with adequate levels. In this meta-analysis, the highest levels were associated with the lowest risk. Furthermore, they found that countries that forti���ed food with vitamin D were not exempt from these deaths. That is, food forti���cation was too low to prevent the early deaths. Scragg R. Seasonality of cardiovascular disease mortality and the possible protective effect of ultra-violet radiation. Int J Epidemiol. 1981 Dec;10(4):337-41. Br��ndum-Jacobsen P, Benn M, Jensen GB, Nordestgaard BG. 25-Hydroxyvitamin D Levels and Risk of Ischemic Heart Disease, Myocardial Infarction, and Early Death: Population-Based Study and Meta-Analyses of 18 and 17 Studies. Arterioscler Thromb Vasc Biol. 2012 Aug 30. Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical ��eld as a general practitioner, itinerant emergency physician, and psychiatrist. 101 SMART TAN MAGAZINE ��� SmartTan.com