The link between vitamin D deficiency and death is a defective activation of the vitamin D receptor (VDR) by 1,25-dihydroxyvitamin D (calcitriol, the vitamin D hormone) to induce/repress genes that maintain mineral homeostasis and skeletal integrity, and prevent secondary hyperparathyroidism, hypertension, immune disorders, and renal and cardiovascular (CV) damage.
Drug-induced CV side effects are undesirable because they may cause long-term CV damage, which puts the patient at greater risk of mortality and morbidity.
Accumulating evidence points to the bidirectional interplay between PTH and aldosterone as an important mechanism behind the increased risk of CV damage observed in PHPT [ 9, 10].
The resulting relative aldosterone excess triggers increased PTH secretion by facilitating renal and fecal calcium loss, which in turn aggravates PTH secretion and CV damage [ 13].
These data suggest that postprandial myocardial perfusion defects are related to impaired coronary microvascular circulation and represent an early marker of diabetic CV damage.
Relative excess of aldosterone may play an important role in the genesis of CV damage even in the absence of primary aldosteronism [ 8].
Although intriguing, more studies are necessary to further elucidate the role of CPPs as a key mediator of CV damage and as a potential therapeutic target in CKD patients.
Some processes intrinsic to the pathogenesis of RA play important roles in CV damage and its clinical consequences: abnormal endothelial function [ 32], autoantibodies against oxidized low-density lipoprotein [ 33], and levels of serum mannose-binding leptin [ 34].
It is important to emphasize that although surrogate markers for CV damage are of interest, such as intima-media thickening at the carotid artery level or biomarkers such as high-sensitivity C-reactive protein, they are not good enough to substantiate final proof for the effectiveness of an intervention as has been seen in the context with the BG-lowering thiazolidinedione rosiglitazone.
"Unless it's hidden by calling it a postdoc," any substantial hiatus in a woman's CV can irreparably damage her career, he says.
