Writing in the journal Nutrients, the researchers provided practical recommendations for implementing personalized supplementation in clinical practice.
“Such a targeted strategy has the potential to optimize cardiovascular outcomes more effectively than a uniform approach to supplementation,” they noted.
The review evaluated findings from observational studies, interventional trials and meta-analyses to clarify vitamin D’s effects on vascular function, inflammation and metabolic pathways.
As emerging evidence points to vitamin D as a key influencing factor for cardiovascular risk and associated mortality, the new consensus spotlights personalized strategies that consider baseline vitamin D levels and comorbid conditions such as diabetes and hypertension.
Vitamin D as a modifiable risk factor for cardiovascular disease
The review suggests that vitamin D deficiency is gaining recognition as a modifiable risk factor for cardiovascular disease.
Vitamin D plays a key role in regulating the Renin–Angiotensin–Aldosterone System (RAAS) by suppressing the expression of renin, a hormone that controls fluid balance and blood pressure. Previous studies have indicated that vitamin D deficiency may lead to upregulation of RAAS, causing hypertension and damage to blood vessels.
The study highlights additional mechanisms by which vitamin D can support cardiovascular health, including regulating lipids and cholesterol, enhancing insulin sensitivity, reducing inflammation and supporting endothelial and muscle cell function.
Synthesizing the evidence
According to the review, observational studies robustly support the association between low vitamin D and death from cardiovascular disease. Randomized controlled trials (RCTs) and meta-analyses show mixed findings.
“While these studies suggest a potential protective role of vitamin D against cardiovascular events and provide valuable insights for hypothesis generation, they do not establish causality,” the researchers wrote.
They note that inconsistencies may be due to factors such as baseline vitamin D status, threshold effects, biological compensation, dosage and duration of supplementation. Additionally, study populations vary in age, physical activity levels, sex, etc.
The reviewers call for future studies that stratify participants, consider comorbid conditions and population differences, and customize dosing.
Recommendations for physicians
The expert consensus provides practical tips for physicians to ensure that supplement strategies are effective and individualized.
Initial assessment in individuals at risk of cardiovascular disease should aim for a 25(OH)D target range of 30–50 ng/mL. These populations include people with limited sun exposure, those with darker skin, older adults and individuals with obesity.
They suggest that correct vitamin D dosages may help manage hypertension, prediabetes and diabetes. Individuals with obesity often exhibit lower vitamin D levels due to sequestration in fat tissues, increasing their cardiovascular risk, the researchers indicated. Therefore, doctors should monitor levels closely, as patients may require higher doses for extended periods.
Additionally, the review recommends that 1000–2000 IU/day of vitamin D may improve cardiac muscle function and reduce inflammation in patients with chronic heart failure. Regular supplementation may improve outcomes for patients with frailty and undergoing cardiac rehabilitation.
The study notes that 25(OH)D is the standard marker for assessing vitamin D status. The active form 1,25(OH)2D is generally not routinely measured because it reflects short-term hormonal regulation rather than overall vitamin D status. However, this may be justified in clinical scenarios where conversion is impaired.
The researchers also highlight the adverse effects of vitamin D overdosing, with toxic effects most often linked to doses exceeding 10,000 IU/day for prolonged periods.
Source: Nutrients
2025, 17(1), 115; doi: 10.3390/nu17010115
“A Personalized Approach to Vitamin D Supplementation in Cardiovascular Health Beyond the Bone: An Expert Consensus by the Italian National Institute for Cardiovascular Research”
Authors: A. Mattioli et al.