Enalapril with renal insufficiency has been reported (10). Vitamin D A meta-analysis on 9 studies, the majority of which found a positive association between high serum 25-hydroxyvitamin D and all-cause mortality in patients with various primary and secondary cardiovascular disease (2,3,4,9), revealed that the RR of mortality was 1.22 (95% CI = 0.95, 1.63) for higher serum 25-hydroxyvitamin D, and 1.31 (95% CI = 1.09, 1.67) for 25-hydroxyvitamin D above 90 nmol/L; in multivariate analysis, this RR estimate was reduced by about 50% (data not shown). A meta-analysis of 4 cohort studies found that serum 25-hydroxyvitamin D levels above 0.8 ng/mL conferred a 13% lower risk of mortality in patients with a primary hypertension, 30% lower risk in patients with a history of myocardial infarction, and a 22% lower risk in patients with chronic kidney disease (10), but it is very difficult to distinguish between associations of serum 25-hydroxyvitamin D measured by 24-hr urinary excretion and those obtained from laboratory tests and clinical assessments. Because we have reported our data on clinical outcomes and trials, we do not find convincing evidence that this association is due to the effect of vitamin D. A number of published meta-analyses have shown a relationship between calcium-fortified orange juice and a decreased mortality risk (8,9,22,23). recent meta-analysis of 15 cohort studies, as well 3 other studies with follow-up to 10 y (24,25), concluded that calcium-fortified orange juice reduced mortality by 10–27%. However, the analysis also found significantly inverse associations between calcium and vitamin D intake all-cause mortality, and a significantly increased risk associated with low calcium intake. These results are conflicting but must be interpreted with caution because of the large number studies that did not show a significant interaction between dietary vitamin D intake and calcium. For example, in the meta-analysis involving studies included in the meta-analysis of vitamin D and mortality by Hwang et al (23) (N = 6) and in the Hwang et al (8) meta-analysis of randomized controlled trials with high vitamin D supplementation on patients with renal failure (N = 6) (12,26), no significant findings on mortality, all-cause or cancer were observed. An cheapest adipex online association of dietary vitamin D intake and cancer death did not differ between the studies in Hwang et al (9.7%) or in the Hwang et al (22%) meta-analysis. This finding may be explained by the high heterogeneity with respect to cause-specific mortality observed in most cases. The Hwang et al (8.1%) and (23.5%) meta-regression analyses revealed that there were only modest changes in the summary RR for cancer among both groups of patients (14). In the Hwang et al (23%) random-effects analysis, however, an increased risk for cancer mortality was noted among the participants who consumed vitamin D from milk and fortified margarine compared with nonfortified (6). However, no significant differences in cancer mortality between the calcium- or vitamin d-treated groups occurred in all-cause mortality when the analyses were stratified in various subgroups (9). For coronary heart disease, a similar heterogeneity in the results for association between calcium and vitamin D intake subsequent cardiovascular mortality has been found. Whereas Hwang et al (9) reported an inverse association with the intake of vitamin D from fortified margarine but not among calcium- or vitamin D-treated patients, in the Hwang et al (23%) random-effects meta-analysis with multivariate adjustment (8), patients in all subgroups were significantly less likely to die of cardiovascular causes when they were supplemented with calcium rather than vitamin D. The results in Hwang et al (8%) and (23%) meta-regression analysis also showed a significant increase in all-cause mortality when both vitamin D intake levels adipex for sale online were in the lowest quartile and when mean serum vitamin D concentration was in the median compared with lowest quartile. No association was observed for calcium intake among participants in the subgroups that did not receive vitamin D in supplemental form but who received calcium pills (13). In our study (9), the vitamin D concentrations in blood of only 6% the participants had a measurable variation (median vitamin D level 4.5% ± 3.1 ng/mL) compared with values of 75% in controls (8) and 100% our study (9). A potential limitation to our study is the relatively small number of participants in the vitamin D plus calcium group of both the Hwang et al (16%) random-effects meta-analysis and the Hwang et al (9%)
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