Stefania E. Makariou, Evangelos N. Liberopoulos, Anna Challa, Moses Elisaf
Low levels of 25-hydroxyvitamin D [25 (OH) VitD] are considered a novel cardiovascular risk factor. Statins, which are widely used for the prevention of cardiovascular disease, have various pleiotropic effects, one of which appears to be the increase of serum 25(OH)VitD levels. In particular, lovastatin, simvastatin, atorvastatin and rosuvastatin seem to be associated with increases in 25(OH)VitD levels. However, the effect of different statins on 25(OH)VitD levels, the underlying mechanism and the existence of a dose-dependent effect, have not yet been clarified. Any possible effects of other lipid-lowering drugs such as fibrates, omega-3 fatty acids, ezetimibe or nicotinic acid on 25(OH)VitD levels remain generally unknown. In a previous study we found that high-dose rosuvastatin (40 mg) and the usual dose of rosuvastatin (10 mg) plus fenofibrate (200 mg) or omega-3 fatty acids (2 g) were associated with similar increases in 25(OH)VitD levels (53%, 64% and 61%, respectively). Ezetimibe may be a moderate inhibitor of 25(OH)VitD intestinal absorption. In one study we found that for the same degree of low-density lipoprotein cholesterol (LDL-C) reduction, monotherapy with simvastatin 40 mg was associated with a more than double increase of 25(OH)VitD levels (79.1%) compared with combination treatment with simvastatin/ezetimibe 10/10 mg (36.7%). In conclusion, the increase in circulating 25(OH)VitD levels by lipid-lowering drugs may be a novel pleiotropic effect, which may contribute to cardiovascular disease risk reduction.