Hormone deficiency may negatively alter response to statin therapy
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Vitamin D and thyroid hormones are important modulators in the treatment of cardiometabolic disease and should be incorporated into clinical decision making, according to a speaker.
Pam R. Taub, MD, FACC, founder and director of Step Family Cardiac Wellness and Rehabilitation Center and professor of medicine at UC San Diego Health, said vitamin D and thyroid hormone deficiencies may reduce a patient’s response to medications and therefore should be monitored.
“Though these hormones may not directly impact CV outcomes, they may modulate other factors, such as response to statin therapy, that are intricately linked to CV outcomes,” Taub said during a presentation at the World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease.
Negative effects of hormone deficiency
Taub said vitamin D and thyroid hormone deficiency could potentially decrease the efficacy of agents such as statins and SGLT2 inhibitors. According to Taub, about 35% of people prescribed statins do not take them due to concerns with statin-associated muscle symptoms. Low vitamin D levels could contribute to statin-related myopathy, and some small studies have reported improvement following vitamin D supplementation. Similarly, studies have shown adults with hypothyroidism have an increased risk for statin-associated muscle symptoms. SGLT2 inhibitors could also cause a decline in vitamin D due to an increase in the cell’s uptake of phosphate, which may trigger body-wide signals that reduce calcium absorption.
“In patients with hyperlipidemia with suboptimal response to statin therapy, consider optimizing their vitamin D and thyroid levels,” Taub said.
Thyroid hormones could also have an impact on statin efficacy. Findings from a study published in Coronary Artery Disease showed men who had intrinsically normal testosterone or normal testosterone after supplementation had a better pleotropic response to statins compared with those with low testosterone.
Low levels of thyroid hormones are also associated with increased lipoprotein A levels, which is the strongest inherited risk factor for early coronary artery disease and is associated with a double to quadruple higher risk for CV events, according to Taub.
Questions surrounding Vitamin D supplementation
Findings on whether vitamin D supplementation can prevention cardiometabolic diseases have been mixed. A randomized double-blind trial published in 2019 in the New England Journal of Medicine found adults with overweight or obesity with prediabetes did not have a reduction in progression to new-onset diabetes with vitamin D supplementation of 4,000 IU daily compared with placebo. However, in a systematic review and meta-analysis published in JAMA Cardiology in 2019, vitamin D supplementation of at least 1,000 IU per day was associated with a reduced risk for type 2 diabetes in people with prediabetes.
In the VITAL study, where men aged 50 years and older and women aged 55 years and older were randomized to 2000 IU of vitamin D daily or placebo, vitamin D supplementation was not associated with a decreased risk for cancer or any CV event. However, Taub said, the findings from VITAL do not negate other data on the benefits of vitamin D.
“Sixty percent of the patients had normal vitamin D levels, only about 12% were vitamin D deficient,” Taub said. “During the trial, patients were allowed to take vitamin D. Those are some things we need to think about because the question is, in people who are truly vitamin D deficient, if you supplement them, are there improvements in outcomes? That question still needs to be answered, but it is difficult to do so (as it is unethical to not supplement patients who are vitamin D deficient) in a large, randomized controlled trial.”
References:
- Barbarawi M, et al. JAMA Cardiol. 2019;doi:10.1001/jamacardio.2019.1870.
- Krysiak R, et al. Coron Artery Dis. 2021;doi:10.1097/MCA.0000000000001031.
- Manson JE, et al. N Engl J Med. 2019;doi:10.1056/NEJMoa1809944.
- Pittas AG, et al. N Engl J Med. 2019;doi:10.1056/NEJMoa1900906.
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Taub P. Impact of hormones on cardiometabolic health. Presented at: World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease; Dec. 2-4, 2021; Los Angeles (hybrid meeting).
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