TreatmentUpdate
185

August/September 2011 

Statins and vitamin D – an unusual relationship

Cholesterol-lowering medications, commonly called statins, are often prescribed by physicians for HIV-positive people. In general, when used correctly and in the right population, statins are generally safe, though they can sometimes affect the concentration of other medicines. In a minority of people who take statins, problems such as muscle weakness and pain can develop. Statins also have anti-inflammatory activity, which may aid in the ability of these drugs to help prevent heart attacks.

Observational studies have found associations between low levels of vitamin D in the blood and an increased risk for cardiovascular complications, including peripheral artery disease and heart attacks. However, because of built-in limitations, observational studies cannot prove that low levels of vitamin D are the cause of peripheral artery disease, heart attacks and other related complications. Still, some scientists remain intrigued by the potential of vitamin D in the area of cardiovascular health, perhaps for at least the following reasons:

  • Cells lining blood vessels contain receptors for vitamin D. Exposure to this vitamin helps restrict the thickening of this lining. Such thickening would otherwise impede the flow of blood.
  • Lab experiments have found that vitamin D can help reduce inflammation. Separate studies suggest that inflammation plays a role in accelerating cardiovascular disease.
  • Vitamin D can very modestly help reduce blood pressure.

Researchers in several countries have conducted experiments with statins to assess their impact on vitamin D in HIV-negative people. Their findings suggest the following:

  • Rosuvastatin (Crestor) can raise vitamin D levels about threefold in the blood.
  • Atorvastatin (Lipitor) can have a similar effect on vitamin D as rosuvastatin.
  • Other statins, such as lovastatin (Mevacor) and simvastatin (Zocor), can also increase the concentration of vitamin D in the blood.
  • In contrast to the statins listed above, fluvastatin (Lescol) does not appear to raise vitamin D levels.

Small studies have found that vitamin D3 supplements at a dose of 800 IU/day can lower levels of atorvastatin (by about 10%) and the chemicals into which it is broken down inside the body. Yet, despite these reduced levels of atorvastatin, the combination of vitamin D and atorvastatin appeared to have increased cholesterol-lowering activity more than either substance did alone.

In general, these studies exploring the impact of statins on vitamin D were small. Larger robust clinical trials will be needed to understand the complex ways in which statins and vitamin D might affect each other’s properties and actions.

—Sean R. Hosein

REFERENCES:

  1. Giannarelli C, Klein RS, Badimon JJ. Cardiovascular implications of HIV-induced dyslipidemia. Atherosclerosis. 2011 Jun 13. [Epub ahead of print]
  2. Grimes DS. Are statins analogues of vitamin D? Lancet. 2006 Jul 1;368(9529):83-6.
  3. Gupta A, Thompson PD. The relationship of vitamin D deficiency to statin myopathy. Atherosclerosis. 2011 Mar;215(1):23-9.
  4. Sathyapalan T, Shepherd J, Arnett C, et al. Atorvastatin increases 25-hydroxy vitamin D concentrations in patients with polycystic ovary syndrome. Clinical Chemistry. 2010 Nov;56(11):1696-700.
  5. Ertugrul DT, Yavuz B, Cil H, et al. STATIN-D Study: Comparison of the influences of Rosuvastatin and Fluvastatin treatment on the levels of 25 Hydroxyvitamin D. Cardiovascular Therapeutics. 2011Apr;29(2):146-152.
  6. Yavuz B, Ertugrul DT, Cil H, et al. Increased levels of 25 hydroxyvitamin D and 1,25-dihydroxyvitamin D after rosuvastatin treatment: a novel pleiotropic effect of statins? Cardiovascular Drugs and Therapy. 2009 Aug;23(4):295-9.
  7. Pérez-Castrillón JL, Vega G, Abad L, et al. Effects of atorvastatin on vitamin D levels in patients wit acute ischemic heart disease. American Journal of Cardiology. 2007 Apr 1;99(7):903-5.
  8. Pérez-Castrillón JL, Abad L, Vega G, et al. Effect of atorvastatin on bone mineral density in patients with acute coronary syndrome. European Review for Medical and Pharmacological Sciences. 2008 Mar-Apr;12(2):83-8.