Vitamin D and Dyslipidemia in Metabolic Syndrome

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  1. Introduction
  2. Managing Dyslipidemia
  3. Vitamin D Status and Metabolic Syndrome
  4. Scope of the Research
  5. Research Question
  6. Research Objective
  7. Research Methodology
  8. Results and Discussion
  9. Conclusion
  10. References

Introduction

Metabolic syndrome has become a common condition amongst populations recently. Metabolic syndrome refers to a group of conditions that work to increase an individual’s risk of diabetes, stroke, or developing heart disease (Patwardhan et al., 2017). Metabolic syndrome specifically has shown the potential to lead to cases of dyslipidemia (Wang et al., 2012). Dyslipidemia refers to the advancement of levels of either or both low-density lipoprotein (LDL) cholesterol or high-density lipoprotein (HDL) cholesterol or triglycerides (TGs), which plays a part in the advancement of atherosclerosis (Morvaridzadeh et al., 2021)3. According to a report by Xi et al (2020), the condition is higher in men compared to women; the authors state that dyslipidemia is common among individuals with obesity, hypertension, smoking and diabetes. According to Rochlani et al. (2017), the condition affects an estimated fifth of the population within the US and a quarter of the European population.

The report also indicates gender and race-based differences in regards to the variation of prevalence of MetS. The condition is 57% higher among African-American women than African American men (AlAnouti et al., 2020). The findings also reveal that Hispanic women had a 26% chance of experiencing (MetS Jin et al., 2020). MetS, also referred to as insulin resistance syndrome, syndrome X, Reaven syndrome, or “the deadly quartet,” are various clinical conditions (Mohamad et al., 2016). Coupled with inflammatory dermatoses like lichen planus, psoriasis a hidradenitis suppurative, MetS is commonly linked with increased atherosclerotic cardiovascular disease (Khosravi, 2018). Currently, the therapeutic alternatives available for dealing with MetS revolve around discrete treatments for hypertension, hypertriglyceridemia, and hyperglycemia (Kelishadi, et al., 2014). Additionally, other interventions include regular exercise and dietary control measures (Javed et al., 2019). Some of the common clinical consequences of the condition include cardiovascular disease and diabetes (Wang et al., 2020).

Managing Dyslipidemia

Management of dyslipidemia is an integral part of improving the health of those at high risk. According to a review by Zodda et al. (2018), currently, statins represent the first-option therapy as they indicate the ability to lower the risk of significant vascular activities by reducing low-density lipoprotein cholesterol (LDL-C). Nonetheless, due to adherence to statin therapy or statin resistance, the majority of the patients fail to attain the LDL-C target levels. Some of the second-choice drugs combined with statins include nicotinic acid, fibrates, and ezetimibe.This combination can be adopted if the lipid targets set are not attained.

For patients with familial hypercholesterolemia (FH) and statin intolerance at very high cardiovascular risk, the anti-PCSK9 drugs, including alirocumab and evolocumab, ensure an effective remedy. The review by Zodda et al. (2018) reveals the impacts of two novel lipid-lowering agents in the management of homozygous FH by limiting LDL-C values and lowering the occurrence of cardiovascular events. Alternative management practices include avoiding smoking, consuming a diet rich in fiber, regular exercise, and consuming a diet with low Trans saturated and saturated fats (Jafari et al., 2016). Vitamin D represents a group of fat-soluble secosteroids critical for enhancing individuals’ lipid profiles and cardiovascular health. Foods rich in vitamin D include fatty fish, egg yolk, and cod liver oil (Hafez et al., 2019). The deficiency of vitamin D indicates a key link to the development of cardiovascular disease and different cardiovascular risk factors like dyslipidemia (Gunasegaran et al., 2021).

Vitamin D Status and Metabolic Syndrome

Globally, there has been concern over vitamin D status, the existence of vitamin D deficiency, and insufficiency (Gasparri et al., 2019). An individual’s vitamin D status can be assessed by measuring the circulating 25 -hydroxyvitamin D [25(OH) D] concentration. Literature by Tangoh et al. (2018) reveals that a score of 25(OH)D levels ≥75 nmol/L (≥30 ng/mL) is sufficient, while insufficient/deficiency levels were considered to be <75 nmol/L. Amongst adults, vitamin D levels of 20 nanograms per milliliter or above represent normal levels of vitamin D (Pinkas, et al., 2017). A review by Park et al. (2018) shows that low serum vitamin D is linked with different types of metabolic illness like diabetes mellitus, cardiovascular diseases like hypertension, insulin resistance and obesity. According to Park et al. (2018), different investigations reveal a connection between deficiency or insufficiency of vitamin D and the risk of metabolic syndrome. Sufficient levels of vitamin D help the body burn more calories (Angellotti et al., 2019).

Scope of the Research

The study aims to determine the role of vitamin D status in modulating dyslipidemia in patients with metabolic syndrome. The study seeks to cover various studies, investigations, and surveys that explain the role of vitamin D in reducing the Risk of Lipid Profile. The research will review the studies around the topic of interest done within the last ten years. This study intends to focus on providing evidence of how vitamin D interacts with lipid levels and vitamin D and lipid profiles in metabolic syndrome individuals (Khayyatzadeh, et al., 2018). Finally, the study will offer its limitations and recommendations regarding the link between vitamin D and lipid profile among individuals with metabolic syndrome.

Research Question

What is the correlation between Vitamin D and lipid profile in individuals with metabolic syndrome?

Research Objective

To find evidence that justifies the positive correlation between vitamin D and Lipids.

Research Methodology

For starting this study, about 50 high-quality papers were selected, the authors of which published them over the past ten years. These works on human studies were subject to careful review and screening. This study looks for a correlation between vitamin D and LDL, a vital marker for the development of cardiovascular disease. The keywords of identification include vitamin D, lipid profile, lipids, vitamin D supplementation, cholesterol, HDL-C, LDL-C.

Results and Discussion

Vitamin D Properties Relative to Dyslipidemia

Dyslipidemia is associated with atypical lipid levels, a risk factor for cardiovascular diseases (Karamali et al., 2017). A study conducted on 3183 Korean children and adolescents linked dyslipidemia with vitamin D deficiency and reduced physical activity (Song et al., 2020). The survey results linked HDL-C to boys who are obese or overweight (Aliashrafi et al., 2019). Similarly, girls with low vitamin D had a higher dyslipidemia occurrence than the boys (Nouri Saeidlou et al., 2017). According to the study’s findings, the reason behind the positive link between 25OHD and HDL-C is elaborated by the link between apolipoprotein A-1 and vitamin D. 1,25-dihydroxy vitamin D subdues apolipoprotein A-1 gene manifestation by changing the actions of coactivators or corepressors (Milajerdi et al., 2020). Additionally, Apolipoprotein A-1 is the primary element of HDL-C. Therefore, the ability of vitamin D to sustain sufficient levels of apolipoprotein A-1 has been recommended as a potential mechanism for the positive correlation between vitamin D with HDL-C in the youth (Liu et al., 2021).

Cardiovascular diseases have become the leading cause of death today, with atherosclerosis being the pathology linked with heightened cholesterol levels (Huang et al., 2021). A review by Warren et al. (2021) explains vitamin D metabolism as a contributory factor; the relationship between vitamin D and cholesterol metabolism can be explained by the defined feedback mechanisms and interactions. The two mechanisms: calcitriol (1,25(OH)D), which enhances INSIG/SREBP mediated feedback; calcidiol (25(OH)D), which inhibits HMGCR activity; and VDR inducing CYP7A1 action, are all steady with the observation that vitamin D insufficiency promotes total cholesterol and LDL-C. The review also observes that vitamin D supplementation suppresses total cholesterol and LDL-C.

Vitamin D and Lipid Profiles with Metabolic Syndrome People

Different human trials tend to link vitamin D with varying lipid profiles among individuals with metabolic syndrome (Fernández-Arroyo et al., 2019). A clinical trial conducted by Liyanage (2017) investigated the impact of high-dose vitamin D on patients with triglycerides (TG), low-density lipoproteins (LDL), high-density lipoproteins (HDL), and total cholesterol (TC). Considered findings indicate heightened serum HDL level within six months of therapy of high dose vitamin D in patients with early diabetic nephropathy (Farag et al., 2019). Similarly, a randomized, double-blind placebo trial on 55 vitamin D deficient women diagnosed with polycystic ovary syndrome (PCOS) revealed that Calcium, vitamin D, and K co-supplementation had beneficial effects on markers of insulin metabolism, serum triglycerides, and VLDL-cholesterol levels (Jorde & Grimnes, 2011).

Various mechanisms can elaborate on the beneficial impacts of combined calcium-vitamin D supplementation on serum triglycerides and VLDL-cholesterol levels (Alves et al., 2021). The intake of Calcium can result in reduced absorption of fatty acids and increased fecal fatty acid content through the development of insoluble calcium-fatty soaps in the gut (Öhlund et al., 2020). This situation, in turn, reduces serum triglycerides and VLDL cholesterol levels (Moghassemi & Marjani, 2014). Additionally, heightened intracellular Calcium in the liver leads to stimulating microsomal triglycerides transfer protein (MTP), leading to reduced VLDL-cholesterol levels and serum triglycerides (Dibaba, 201940).

Administration of vitamin D has shown significant contribution in enhancing the lipid profile of subjects. According to a randomized trial by Samaranayake (2020), strict dietary intake and physical activity plans show improvement in body composition and anthropometric and metabolic profiles. Additionally, another trial by Holt et al. (2022) reveals high dose vitamin D supplementation has a beneficial impact on the homeostasis of glucose and HDL cholesterol levels amongst infertile men. A study by Garcia et al. (2019) also reveals a positive correlation between administration of Vitamin D and improvement of total levels of cholesterol, apolipoprotein B100, and low-density lipoprotein cholesterol. Possible mechanisms by which vitamin D may affect lipid metabolism are the suppression of the expression of enzyme 3-hydroxy-3-methylglutaryl coenzyme-A reductase with a consequent decrease in cholesterol synthesis (Almaghrbi et al., 2021). Alternatively, the influence may be indirectly by raising calcium absorption, which enhances a reduction in TC by conversion into bile acid (Ferreira et al., 2020).

Limitations and Recommendations

Different clinical human trials seek to identify the impact of vitamin D on the lipid profile of individuals with metabolic syndrome. The majority of the research findings reveal a positive correlation between vitamin D administration and the improvement of lipid profile among vitamin D deficient subjects (Hauger et al., 2020). However, the primary limitations that affect the study revolve around the differences in quality and significance of certain research to a clinical question (Hama et al., 2021). Controversial findings by AlAnouti et al. (2020) reveal that vitamin D supplementation (VDS) does not affect blood lipids in adults with MetS. These research findings indicate further research is needed to ascertain whether vitamin D supplements affect blood lipids in adults with MetS (Challoumas, 2014).

The research review articles have the potential of biasness due to the impact of the author’s viewpoints. There might also exist some gaps within the literature searching activities that can lead to the omission of crucial research or errors in data translation (Ponda, 2012a; Ponda, 2012b). This situation occurs from primary literature to summarization within the review, where one can fall to misinterpretation or misrepresentation of source data issues (Bašić et al., 2019). Nonetheless, vitamin D supplementation is recommended for individuals experiencing unhealthy lipid profiles (Dziedzic et al., 2016).

Conclusion

The metabolism of cholesterol and vitamin D has a complex relationship. Evidence indicates that heightened cardiovascular risk is linked with a deficiency in vitamin D. Different clinical trials explain the interaction of vitamin D and lipid profiles of the subjects. These studies help our understanding of the relationship between vitamin D and lipid profiles for individuals with metabolic syndrome. However, further research is needed to ascertain the effect of vitamin D on improving lipid profiles of individuals with MetS, as contrary research findings exist.

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