Influence of Vitamin D in Arterial Stiffness: A Systematic Review

Abstract

Background: Arterial stiffness is a strong predictor of cardiovascular morbidity and mortality. Vitamin D deficiency has been implicated in vascular dysfunction, yet the effect of supplementation on arterial stiffness remains controversial.

Objectives: To systematically review and synthesize evidence from randomized controlled trials (RCTs), observational studies, and meta-analyses on the relationship between vitamin D and arterial stiffness.

Methods: A comprehensive search identified 21 studies (5 RCTs, 12 meta-analyses, 4 observational cohorts) evaluating vitamin D supplementation or status in relation to measures of arterial stiffness (pulse wave velocity, augmentation index, carotid intima-media thickness). Data were extracted on study design, population, baseline vitamin D status, intervention characteristics, and outcomes.

Results: Observational studies consistently demonstrated an inverse association between serum 25(OH)D and arterial stiffness across diverse populations. Among RCTs, approximately one-third reported significant improvements in stiffness with supplementation, particularly in vitamin D–deficient individuals and patients with peripheral arterial disease. In contrast, most trials in vitamin D–replete or CKD populations reported null effects. Meta-analyses confirmed small to null pooled benefits but highlighted improvements when supplementation was targeted to deficient groups and administered as oral cholecalciferol for ≥12 weeks. Mechanistic evidence supports roles for vitamin D in endothelial function, RAAS modulation, and vascular inflammation.

Conclusions: Vitamin D supplementation exerts conditional vascular benefits, improving arterial stiffness primarily in deficient individuals, while evidence for universal supplementation remains weak. Clinical practice should prioritize deficiency correction and individualized approaches. Further stratified RCTs with longer follow-up are required to determine whether these improvements translate into reduced cardiovascular risk.