Optimum dose of vitamin D for disease prevention in older people: BEST-D trial of vitamin D in primary care

Hin, Harold; Tomson, Joseph; Newman, Connie B.; Kurien, Rijo; Lay, Michael; Cox, Jolyon; Sayer, Jenny; Hill, Michael; Emberson, Jonathan; Armitage, Jane; Clarke, Robert

doi:10.1007/s00198-016-3833-y

Cited by 63 publications

(115 citation statements)

References 47 publications

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“…A total of 31 trials, involving 2751 participants, were eligible for inclusion in the review . Of these, 29 trials (2641 participants) had data suitable for inclusion in the trial‐level meta‐analyses; IPD were obtained from 24 trials (2051 participants).…”

Section: Resultsmentioning

confidence: 99%

Effect of Vitamin D Supplementation on Markers of Vascular Function: A Systematic Review and Individual Participant Meta‐Analysis

Beveridge

Khan

Struthers

et al. 2018

JAHA

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BackgroundLow 25‐hydroxyvitamin D levels are associated with an increased risk of cardiovascular events, but the effect of vitamin D supplementation on markers of vascular function associated with major adverse cardiovascular events is unclear.Methods and ResultsWe conducted a systematic review and individual participant meta‐analysis to examine the effect of vitamin D supplementation on flow‐mediated dilatation of the brachial artery, pulse wave velocity, augmentation index, central blood pressure, microvascular function, and reactive hyperemia index. MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and http://www.ClinicalTrials.gov were searched until the end of 2016 without language restrictions. Placebo‐controlled randomized trials of at least 4 weeks duration were included. Individual participant data were sought from investigators on included trials. Trial‐level meta‐analysis was performed using random‐effects models; individual participant meta‐analyses used a 2‐stage analytic strategy, examining effects in prespecified subgroups. 31 trials (2751 participants) were included; 29 trials (2641 participants) contributed data to trial‐level meta‐analysis, and 24 trials (2051 participants) contributed to individual‐participant analyses. Vitamin D3 daily dose equivalents ranged from 900 to 5000 IU; duration was 4 weeks to 12 months. Trial‐level meta‐analysis showed no significant effect of supplementation on macrovascular measures (flow‐mediated dilatation, 0.37% [95% confidence interval, −0.23 to 0.97]; carotid‐femoral pulse wave velocity, 0.00 m/s [95% confidence interval, −0.36 to 0.37]); similar results were obtained from individual participant data. Microvascular function showed a modest improvement in trial‐level data only. No consistent benefit was observed in subgroup analyses or between different vitamin D analogues.ConclusionsVitamin D supplementation had no significant effect on most markers of vascular function in this analysis.

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Section: Resultsmentioning

confidence: 99%

Effect of Vitamin D Supplementation on Markers of Vascular Function: A Systematic Review and Individual Participant Meta‐Analysis

Beveridge

Khan

Struthers

et al. 2018

JAHA

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“…Information was recorded directly into bespoke electronic case report forms and included medical history, presence of vascular risk factors, and medication use. Blood samples were collected and physical measurements recorded as previously described . Study visits were scheduled at the same time of the day to minimize any effects of diurnal variation and participants were advised to avoid alcohol, tea, and coffee before each visit.…”

Section: Methodsmentioning

confidence: 99%

“…The BEST‐D (Biochemical Efficacy and Safety Trial of vitamin D) trial evaluated the safety and efficacy of daily supplementation with high‐dose vitamin D (4000 IU or 2000 IU daily) or placebo for 1 year among older people living in Oxfordshire, United Kingdom, as a pilot study for a large trial of vitamin D for prevention of CVD, fracture, and cancer . The results of the primary outcomes of the BEST‐D trial of the effects of supplementation with vitamin D versus placebo on plasma concentrations of 25(OH)D and other plasma markers of vitamin D status have been previously published .…”

Section: Introductionmentioning

confidence: 99%

Effects of Vitamin D on Blood Pressure, Arterial Stiffness, and Cardiac Function in Older People After 1 Year: BEST‐D (Biochemical Efficacy and Safety Trial of Vitamin D)

Tomson

Hin

Emberson

et al. 2017

JAHA

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BackgroundThe relevance of vitamin D for prevention of cardiovascular disease is uncertain. The BEST‐D (Biochemical Efficacy and Safety Trial of vitamin D) trial previously reported effects of vitamin D on plasma markers of vitamin D status, and the present report describes the effects on blood pressure, heart rate, arterial stiffness, and cardiac function.Methods and ResultsThis was a randomized, double‐blind, placebo‐controlled trial of 305 older people living in United Kingdom, who were allocated vitamin D 4000 IU (100 μg), vitamin D 2000 IU (50 μg), or placebo daily. Primary outcomes were plasma concentrations of 25‐hydroxy‐vitamin D and secondary outcomes were blood pressure, heart rate, and arterial stiffness in all participants at 6 and 12 months, plasma N‐terminal prohormone of brain natriuretic peptide levels in all participants at 12 months, and echocardiographic measures of cardiac function in a randomly selected subset (n=177) at 12 months. Mean (SE) plasma 25‐hydroxy‐vitamin D concentrations were 50 (SE 2) nmol/L at baseline and increased to 137 (2.4), 102 (2.4), and 53 (2.4) nmol/L after 12 months in those allocated 4000 IU/d, 2000 IU/d of vitamin D, or placebo, respectively. Allocation to vitamin D had no significant effect on mean levels of blood pressure, heart rate, or arterial stiffness at either 6 or 12 months, nor on any echocardiographic measures of cardiac function, or plasma N‐terminal prohormone of brain natriuretic peptide concentration at 12 months.ConclusionsThe absence of any significant effect of vitamin D on blood pressure, arterial stiffness, or cardiac function suggests that any beneficial effects of vitamin D on cardiovascular disease are unlikely to be mediated through these mechanisms.Clinical Trial Registration URL: https://www.clinicaltrialsregister.eu/ctr-search/search. Unique identifier: EudraCT number: 2011–005763‐24a

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“…Older individuals are not routinely included in research testing ODS products. For example, researchers have not yet identified the optimal amount of vitamin D supplementation that minimises cardiovascular or renal system effects in older adults (Hin et al, ). In clinical practice, supplement dose and toxicities are not routinely monitored in the geriatric population (Bailey, Gahche, Miller, Thomas, & Dwyer, ; Geller et al, ; Gurley, ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of oral dietary supplement use in rural older adults

Shade

Witry

Robinson

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To describe and explore characteristics associated with oral dietary supplement use and identify potential interactions with prescription medications in a sample of rural community‐dwelling older adults. Background Older adults use polypharmacy to help manage chronic diseases. Due to healthcare access disparities, rural older adults may consider dietary supplement use as an alternative approach to maintain health and manage disease. Oral dietary supplement use is expected to increase among ageing adults; placing them at risk for potential interactions and adverse events. Design A secondary analysis was conducted on oral dietary supplement, medication and health characteristic data collected on N = 138 participants. The original study was adherent to STROBE guidelines. Results Researchers found that 83% of the rural older adults used oral dietary supplements in addition to their prescribed medications. Participants took additional single‐dose vitamins along with their multivitamin; 57% took vitamin D, 52% took calcium, 15% took vitamin C and 13% took additional potassium and vitamin E. Participants also used oral dietary supplements with medications that had a potential for interaction. Conclusions Compared with national samples of older adults, a high percentage of rural older adults used oral dietary supplements in addition to their prescribed medications. In the rural setting, older adults are at risk for potential drug–oral dietary supplement interactions. Relevance to clinical practice Nurses can conduct vigilant medication reconciliation that includes documenting characteristics of oral dietary supplement use. Nurses can assist with providing appropriate dietary supplements education that promotes patient knowledge and prevent inappropriate use; particularly when caring for older adults from rural settings.

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Optimum dose of vitamin D for disease prevention in older people: BEST-D trial of vitamin D in primary care

Cited by 63 publications

References 47 publications

Effect of Vitamin D Supplementation on Markers of Vascular Function: A Systematic Review and Individual Participant Meta‐Analysis

Effect of Vitamin D Supplementation on Markers of Vascular Function: A Systematic Review and Individual Participant Meta‐Analysis

Effects of Vitamin D on Blood Pressure, Arterial Stiffness, and Cardiac Function in Older People After 1 Year: BEST‐D (Biochemical Efficacy and Safety Trial of Vitamin D)

Analysis of oral dietary supplement use in rural older adults

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