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The aim of the present paper was to review the most important mechanisms explaining the possible association of vitamin Ddeficiency and cardiovascular diseases, focusing on recent experimental and clinical data. LowvitaminDlevels favor atherosclerosisenabling vascular inflammation, endothelial dysfunction, formation of foam cells, and proliferation of smooth muscle cells. Theantihypertensive properties of vitamin D include suppression of the renin-angiotensin-aldosterone system, renoprotective effects,direct effects on endothelial cells and calcium metabolism, inhibition of growth of vascular smooth muscle cells, preventionof secondary hyperparathyroidism, and beneficial effects on cardiovascular risk factors. Vitamin D is also involved in glycemiccontrol, lipidmetabolism, insulin secretion, and sensitivity, explaining the association between vitamin D deficiency andmetabolicsyndrome. Vitamin D deficit was associated in some studies with the number of affected coronary arteries, postinfarctioncomplications, inflammatory cytokines and cardiac remodeling in patients with myocardial infarction, direct electromechanicaleffects and inflammation in atrial fibrillation, and neuroprotective effects in stroke. In peripheral arterial disease, vitamin Dstatus was related to the decline of the functional performance, severity, atherosclerosis and inflammatory markers, arterialstiffness, vascular calcifications, and arterial aging. Vitamin D supplementation should further consider additional factors, suchas phosphates, parathormone, renin, and fibroblast growth factor 23 levels.
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