scholarly journals Vitamin D Serum Levels in Subjects Tested for SARS-CoV-2: What Are the Differences among Acute, Healed, and Negative COVID-19 Patients? A Multicenter Real-Practice Study

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3932
Author(s):  
Luca Gallelli ◽  
Gaia Chiara Mannino ◽  
Filippo Luciani ◽  
Alessandro de Sire ◽  
Elettra Mancuso ◽  
...  
Keyword(s):  
Vitamin D ◽  
Hypovitaminosis D ◽  
Serum Levels ◽  
Male Gender ◽  
Active Vitamin ◽  
Significant Difference ◽  
Male Patients ◽  
Practice Study ◽  
Real Practice ◽  
Fast Acting

Vitamin D might play a role in counteracting COVID-19, albeit strong evidence is still lacking in the literature. The present multicenter real-practice study aimed to evaluate the differences of 25(OH)D3 serum levels in adults tested for SARS-CoV-2 (acute COVID-19 patients, subjects healed from COVID-19, and non-infected ones) recruited over a 6-month period (March–September 2021). In a sample of 117 subjects, a statistically significant difference was found, with acute COVID-19 patients demonstrating the lowest levels of serum 25(OH)D3 (9.63 ± 8.70 ng/mL), significantly lower than values reported by no-COVID-19 patients (15.96 ± 5.99 ng/mL, p = 0.0091) and healed COVID-19 patients (11.52 ± 4.90 ng/mL, p > 0.05). Male gender across the three groups displayed unfluctuating 25(OH)D3 levels, hinting at an inability to ensure adequate levels of the active vitamin D3 form (1α,25(OH)2D3). As a secondary endpoint, we assessed the correlation between serum 25(OH)D3 levels and pro-inflammatory cytokine interleukin-6 (IL-6) in patients with extremely low serum 25(OH)D3 levels (<1 ng/mL) and in a subset supplemented with 1α,25(OH)2D3. Although patients with severe hypovitaminosis-D showed no significant increase in IL-6 levels, acute COVID-19 patients manifested high circulating IL-6 at admission (females = 127.64 ± 22.24 pg/mL, males = 139.28 ± 48.95 ng/mL) which dropped drastically after the administration of 1α,25(OH)2D3 (1.84 ± 0.77 pg/mL and 2.65 ± 0.92 ng/mL, respectively). Taken together, these findings suggest that an administration of 1α,25(OH)2D3 might be helpful for treating male patients with an acute COVID-19 infection. Further studies on rapid correction of vitamin D deficiency with fast acting metabolites are warranted in COVID-19 patients.

scholarly journals Vitamin D Deficiency and Psoriasis: A Cross-Sectional study of Iranian Population in Yazd Province

2020 ◽  
Author(s):  
Mohammad Ebrahimzadeh Ardakani ◽  
Mohammad Afkhami-Ardekani ◽  
Mohammad Reza Taghizadeh Yazdi ◽  
Nasim Namiranian ◽  
Farideh Radmehr
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Hypovitaminosis D ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Significant Difference

Objective: Psoriasis is an inflammatory disease of the skin and the joints. Psoriatic patients sometimes suffer from vitamin D deficiency and hypocalcemia. The aim of our study was to evaluate the level of calcium and vitamin D in patients with psoriasis. Materials and Methods: In this analytical cross sectional study, 110 cases of psoriasis that were referred to Shohadaye Mehrab clinic during 2015 and 110 non-psoriatic patients enrolled. Serum levels of calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase (ALK) and 25- hydroxy vitamin D3 [(25OH) D3] were measured in both groups. Data were analyzed using SPSS software version 19. Chi square test and T-test were used for statistical analysis. Results: Among110 patients with psoriasis 74 (67.3%) were men and 36 (32.75%) were women. There was no significant difference in the serum level of calcium (P-value: 0.563), phosphorus (P-value: 0.381), PTH (P-value: 0.364) and ALK (P-value: 0.639) between two groups. Vitamin D deficiency was found in 64.5% of psoriatic patients and 60% of the controls (P-value= 0.45); However 30.9% of psoriatic and 17.3% of the controls suffered from severe hypovitaminosis D. This difference was statistically significant (Pvalue= 0.014).Conclusion: We found a significant relationship between severe hypovitaminosis D and psoriasis. This finding revealed the need for evaluation of psoriatic patients for the presence of vitamin D deficiency.

scholarly journals Role of vitamin D serum levels in prevention of primary and recurrent melanoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Lombardo ◽  
A. Vigezzi ◽  
G. Ietto ◽  
C. Franchi ◽  
V. Iori ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Levels ◽  
Mitotic Rate ◽  
Control Group ◽  
Healthy Population ◽  
Histological Subtype ◽  
Melanoma Diagnosis ◽  
Significant Difference ◽  
Tumour Location

AbstractPatients afflicted with melanoma show lower vitamin D serum levels (VDSL) than the healthy population. This hypothesis agrees with its well-known antiproliferative features. An observational study was carried out to collect VDSL in patients suffering from melanoma. Our aim was to identify a potential connection between low VDSL and the risk to incur melanoma. Furthermore, we studied the association between VDSL at the diagnosis of melanoma and other germane prognostic factors. The population held in regard was composed of 154 patients with a diagnosis of melanoma between 2016 and 2019. These patients were retrospectively collected from our follow-up storage. We compared VDSL to clinical and pathological parameters (age, sex, tumour location, Breslow’s depth, Clark’s level, histological subtype, ulceration, et aliqua). Moreover, we recruited a control group with negative melanoma history. Mean and median of VDSL were significantly lower in the melanoma group. Instead, we found a negative association between melanoma and VDSL > 30 ng/L (OR 0.11; p < 0.0001). No correlation between VDSL and both Breslow’s depth and Clark’s level was discovered, but the VDSL comparison between thin (depth ≤ 1 mm) and thick tumours (depth > 1 mm) revealed a statistically significant difference (21.1 ± 8.2 ng/L vs 17.8 ± 8.1; p = 0.01). Moreover, VDSL were significantly lower in melanomas with mitotic rate ≥ 1/mm2 (22.1 ± 8.3 ng/L; p < 0007). Nevertheless, no connection was found between VDSL and both ulceration and positive sentinel nodes (p = 0.76; p = 0.74). Besides, our study revealed no association between VDSL and histological subtype (p = 0.161). Lower VDSL correlate with thick and high mitotic rate tumours. Future prospective studies would investigate if appropriate upkeep of suitable VDSL can decrease the risk of primary and recurrent melanoma diagnosis.

scholarly journals Vitamin D and Serum Cytokines in a Randomized Clinical Trial

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Eleanor Yusupov ◽  
Melissa Li-Ng ◽  
Simcha Pollack ◽  
James K. Yeh ◽  
Mageda Mikhail ◽  
...  
Keyword(s):  
Vitamin D ◽  
Placebo Group ◽  
Vitamin D3 ◽  
Intracellular Signaling ◽  
Final Visit ◽  
Active Vitamin ◽  
Gm Csf ◽  
Active Vitamin D ◽  
Significant Difference ◽  
Vitamin D3 Supplementation

Background. The role of vitamin D in the body's ability to fight influenza and URI's may be dependent on regulation of specific cytokines that participate in the host inflammatory response. The aim of this study was to test the hypothesis that vitamin D can influence intracellular signaling to regulate the production of cytokines.Subjects and Methods. This study was a 3-month prospective placebo-controlled trial of vitamin D3 supplementation in ambulatory adults [Li-Ng et al., 2009]. 162 volunteers were randomized to receive either 50 μg/d(2000 IU) of vitamin D3 or matching placebo. 25(OH)D and the levels of 10 different cytokines (IL-2, 4, 5, 6, 8, 10, 13, GM-CSF, IFN-γ, TNF-α) were measured in the serum of participants at baseline and the final visit. There were 6 drop-outs from the active vitamin D group and 8 from the placebo group.Results. In the active vitamin D group, we found a significant median percent decline in levels of GM-CSF (−62.9%,P<.0001), IFN-γ(−38.9%,P<.0001), IL-4 (−50.8%,P=.001), IL-8 (−48.4%,P<.0001), and IL-10 (−70.4%,P<.0001). In the placebo group, there were significant declines for GM-CSF (−53.2%,P=.0007) and IFN-γ(−34.4%,P=.0011). For each cytokine, there was no significant difference in the rate of decline between the two groups. 25(OH)D levels increased in the active vitamin D group from a mean of64.3±25.4 nmol/L to88.5±23.2 nmol/L.Conclusions. The present study did not show that vitamin D3 supplementation changed circulating cytokine levels among healthy adults.

Analysis of Suicidal Behavior and Chronicity of Depressive Symptoms in the Presence of Hypovitaminosis D

2021 ◽  
Vol 17 ◽  
Author(s):  
Catarina Magalhães Porto ◽  
Natalia Santos Barbosa da Silva ◽  
Cecília Magalhães Porto Lira ◽  
Rayana Porpino Magalhães ◽  
José Luiz Oliveira Magalhães ◽  
...  
Keyword(s):  
Vitamin D ◽  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Depressive Disorder ◽  
Suicidal Behavior ◽  
Suicide Risk ◽  
Hypovitaminosis D ◽  
Serum Levels ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

Background: One of the risk factors for suicide includes the presence of depressive disorder and symptoms, which may be related to the reduction of 25-hydroxyvitamin D serum levels. In this scenario, evidence shows vitamin D deficiency as an important aspect, directly related to depressive disorder chronicity. Objective: To assess the association between Vitamin D serum levels and the intensity of depressive symptoms and suicidal behavior in a clinical sample of depressed patients. Methods: A cross-sectional study with 146 patients aged between 18 and 59, seen in two psychiatry ambulatories. Data collection involved measurement of serum 25-hydroxyvitamin D levels and assessment of the intensity of depressive symptoms and suicide risk. Results: In the sample, 35% presented low Vitamin D serum levels and, in these individuals, the incidence of family history of Depressive Disorder (95.2%) and chronicity of severe depressive symptoms (47.8%) was higher. As to suicidal behavior, both groups presented high active suicide risk, with higher rates in the group with hypovitaminosis D. Only suicidal ideation was linked to lower Vitamin D levels (67.4% p= 0,005). Conclusion: In this study, hypovitaminosis D was associated with negative mental health outcomes, such as more severe chronicity of depressive symptoms and suicidal behavior, characterized by active suicidal ideation.

scholarly journals Alert for bone alterations and low serum concentrations of vitamin D in patients with intestinal inflammatory disease

2017 ◽  
Vol 63 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Lorete Maria da Silva Kotze ◽  
◽  
Carolina Tabata Costa ◽  
Murilo Franco Cavassani ◽  
Renato Mitsunori Nisihara ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
Bone Changes ◽  
Bowel Diseases ◽  
Intestinal Inflammatory Disease ◽  
Irritable Bowel

Summary Background: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are characterized by chronic inflammation of the intestine that can reduce the absorption of nutrients such as vitamin D and calcium. Objective: To investigate bone alterations and serum levels of vitamin D in patients with IBD. Method: This was a cross-sectional study based on a review of medical records of patients from a private office in Curitiba, PR, Brazil. Serum levels of vitamin D and bone densitometry were measured at diagnosis of IBD. A total of 105 patients were included; 38 (58.4%) with CD; 27 (41.6%) with UC and 40 with irritable bowel syndrome (IBS) as comparison group. Results: When compared to patients with UC, CD patients showed a higher prevalence of bone alterations, being 15.8% with osteoporosis and 36.8% with osteopenia. In UC, bone alterations occurred in 29.6% of cases, 3.7% with osteoporosis and 25.9% with osteopenia. As for vitamin D levels, among CD patients, 10.5% had vitamin deficiency, 65.8% insufficiency and 23.7% were sufficient. In UC, 7.4% of cases had deficiency, 74.1% insufficiency and 18.5% had sufficient serum levels of vitamin D. In the group with IBS, deficiency was observed in 17.5% of cases, insufficiency in 55% and sufficiency in 27.5% of them. There was no significant difference between groups. Conclusion: IBD patients have a high prevalence of bone changes, especially those with CD. Serum levels of vitamin D are below the recommended in all the evaluated groups.

scholarly journals Treatment Failure of Active Vitamin D Therapy in Chronic Kidney Disease: Predictive Factors

2015 ◽  
Vol 42 (3) ◽  
pp. 228-236 ◽  
Author(s):  
Mario Cozzolino ◽  
Adrian Covic ◽  
Blanca Martinez-Placencia ◽  
Konstantinos Xynos
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Treatment Failure ◽  
Serum Levels ◽  
Clinical Effects ◽  
Active Vitamin ◽  
Ipth Level ◽  
Active Vitamin D ◽  
Vitamin D Levels

Background: In patients with chronic kidney disease (CKD), impaired renal function leads to decreased vitamin D levels, which causes an increase in parathyroid hormone (PTH) production and contributes to the development of secondary hyperparathyroidism (SHPT). This may result in adverse clinical effects such as bone disorders, vascular calcification, cardiovascular disease, and increased mortality. Current treatment practices and associated outcomes with active vitamin D treatment in patients with CKD were reviewed with the objective to assess parameters (such as PTH and serum calcium levels) that may be used to define the failure of vitamin D treatment. Summary: Reports based on observational data have noted improved outcomes with active vitamin D treatment (calcitriol, paricalcitol, alfacalcidol, or doxercalciferol) in patients with CKD. Criteria for the identification of active vitamin D treatment failure are unclear from current guidelines, although up to 50% of patients may experience treatment failure eventually because of development of hypercalcemia or resistant SHPT, characterized by an elevated intact PTH (iPTH) level despite treatment. We propose a definition of vitamin D treatment failure as iPTH >600 pg/ml after 6 months of intravenous active vitamin D treatment and corrected total calcium serum levels >10.2 mg/dl, and review factors that may predict the response to vitamin D treatment. Key Message: Active vitamin D treatment failure is an important challenge in clinical practice. The aim of the proposed definition is to suggest a possible framework for hypothesis generation and to encourage further research into this common problem.

scholarly journals The relationship between serum vitamin D level and COVID-19; a review study

2020 ◽  
Vol 5 (2) ◽  
pp. e34-e34
Author(s):  
Yasaman Koohshoori ◽  
Ehsan Ramanian ◽  
Nasrin Moradi ◽  
Shahrzad Shadabi ◽  
Minoo Motahhar ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Vitamin ◽  
Length Of Hospital Stay ◽  
Hypovitaminosis D ◽  
Serum Levels ◽  
Potential Effect ◽  
Hydroxyvitamin D ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
The Relationship

Introduction: Coronavirus disease 2019 (COVID-19) from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is one of the most important epidemiological events in the past 100 years has become, the consequences for public health and economic systems around the world. Vitamin D is an important micronutrient that has been reported to improve immunity and protect against respiratory diseases. In this study, we intend to review articles that examine the relationship between COVID-19 and vitamin D. Methods: This is a review that uses articles from studies published in 2020 on the relationship between COVID-19 and vitamin D in databases such as; Web of Science, Science Direct, SID, Magiran, Google Scholar and PubMed. Keywords used included; serum levels of 25-hydroxyvitamin D, vitamin D, COVID-19, SARS-COV-2 and coronavirus 2. With this search, 32 articles were finally selected for this purpose and their results were reviewed Results: Of the 32 studies reviewed, only three showed no association between vitamin D levels in the blood and COVID-19 disease. Other studies had a relationship between the severity of the disease, mortality rate and length of hospital stay, in different age, gender and location groups. Conclusion: It seems that the level of vitamin D in the blood has a potential effect on COVID-19 disease. Checking the serum vitamin D levels and supplementation in people with hypovitaminosis D can be a good solution to reduce the complications and problems caused by COVID-19.

scholarly journals PARATHYROID HORMONE AND BIOCHEMICAL METABOLIC BONE MARKERS IN PATIENTS WITH β-THALASSEMIA MAJOR IN MISAN PROVINCE / IRAQ

2020 ◽  
Vol 17 (35) ◽  
pp. 65-72
Author(s):  
Noor AL-Huda Salah AL-ZUHAIRY ◽  
Zainab Abdul Jabbar Ridha AL-ALI
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Thalassemia Major ◽  
Control Group ◽  
Female Patients ◽  
Metabolic Bone ◽  
Significant Difference ◽  
Calcium Phosphorus ◽  
Male Patients ◽  
Serum Pth

Beta-thalassemia is a heterogeneous group of hereditary blood disorders characterized by defects in the synthesis of the β- chains of hemoglobin, resulting in variable phenotypes ranging from severe anemia to clinically asymptomatic individuals. This study aims to assess the serum PTH, vitamin D, calcium, phosphorus, alkaline phosphatase, and magnesium levels in β-thalassemia major patients. A total of 50 (30 male and 20 female) patients with β- thalassemia major with ages range 11- 16 years and an equal number of sex-matched healthy adolescents as a control group were included in this study. A total of 52% of patients were lived in an urban area, and there was no significant difference between patients and the control group regarding residency. Male patients showed low statistically significant (P 0.05) mean serum PTH, vitamin D, and calcium levels, but mean serum phosphorus and alkaline phosphatase levels were significantly higher (P 0.05) as compared to the male control group. However, female patients had low, but without statistical significant (P>0.05) mean serum PTH level, whereas vitamin D and calcium levels were highly significant (P 0.05) reduced. The phosphorus and ALP levels were highly significantly (P 0.05) increased as compared to female controls. Regarding β- thalassemia major group, the current study showed male patients had non-significant (P 0.05) higher levels of PTH, calcium, phosphorus, and ALP. In contrast, vitamin D level was non-significantly (P 0.05) low in male patients as compared to female patients. Mean serum level of PTH had a negative correlation with phosphorus, but it had a positive association with vitamin D, calcium, ALP, and magnesium. In conclusion, this study demonstrated that β-thalassemia major patients have a markedly deranged biochemical metabolic bone profile. Regular monitoring of PTH and biochemical mineral profile is also recommended.

scholarly journals Effect of Vitamin D Supplementation on Clinical and Radiographic Evaluation of Oral Rehabilitation with Osseointegrated Implants

2019 ◽  
Vol 21 (5) ◽  
pp. 518-522
Author(s):  
Adriano Piccolotto ◽  
Gisele Toyama ◽  
Mauro Busato ◽  
Adriane Yaeko Togashi
Keyword(s):  
Vitamin D ◽  
Serum Levels ◽  
Vitamin D Supplementation ◽  
Radiographic Evaluation ◽  
Oral Rehabilitation ◽  
Radiographic Findings ◽  
Vitamina D ◽  
Dental Implantation ◽  
Osseointegrated Implants ◽  
Significant Difference

Abstract   Vitamin D (VD) is important for the development and maintenance of bone tissue. This study used clinical and radiographic evaluations to analyze whether insufficient VD levels affect the periimplant health of patients with implant-supported prostheses. Data were collected for 33 patients with implant-supported prostheses: probing depth (PD); width of keratinized mucosa (wKM); bleeding index (mBI); periimplant plaque index (mPI); distance from implant to bone crest and VD level using chemiluminescence. After 1 year of implant-supported prosthesis installation, patients with levels under 30 ng/ml at baseline received 50000 IU of VD per week for 8 weeks (post treatment, PT), when clinical and radiographic evaluations were repeated for the control (n=19) and the VD (n=14) groups. Clinical and radiographic results were compared at baseline and at PT.  There were differences in PD (p=0.0247) and distance from implant to bone crest (p<0.0001), but there were not statistically different after supplementation.  wMK, mBI and mPI were not statistically different between groups.  VD levels were 24.95 ± 0.96 ng/mL in the VD group (42.42% of patients), whereas 57.57% of all participants had a mean VD value of 40.99 ± 1.23 ng/mL, a statistically significant difference (p = 0.0034). According to clinical and radiographic findings, VD serum levels do not seem to affect periimplant health. Keywords: Bone Density. Clinical Study. Dental Implantation.  ResumoA vitamina D (VD) é importante para o desenvolvimento e a manutenção do tecido ósseo. Este estudo clínico e radiográfico avaliou a reposição dos níveis de vitamina D na saúde periimplantar de pacientes com próteses implantossuportadas. Profundidade bolsa a sondagem (PS), largura da mucosa queratinizada (LMQ), sangramento a sondagem (mBI), presença de placa bacteriana (mPI), distância entre implante e cristas ósseas e dosagem de VD utilizando o teste de quimioluminescência, foram medidos em 33 pacientes. Pacientes com dosagens acima de 30 ng/ml foram classificados como suficientes de VD (grupo controle, n = 19). Pacientes com menos de 30ng/ml (grupo VD, n = 14) receberam, após 1 ano da instalação da prótese sobre implante, reposição de 50.000 UI por semana durante 8 semanas, quando os exames foram repetidos. Dados iniciais intragrupos, bem como dados iniciais e pós-tratamento (PT) intergrupos e intragrupos, foram comparados. Diferenças estatísticas foram encontradas em PS (p=0.0247) e distância entre crista óssea e implante (p<0.0001) entre os grupos, mas não após reposição. Não houve diferença em LMQ, mBI e mPI entre os grupos. O valor médio de VD do grupo VD foi 24,95±0.96 ng/ml para 42,42% dos pacientes, enquanto 57,57% da amostra apresentaram valor médio de 40,99±1.23 ng/ml, demonstrando diferença estatística (p=0.0034). A reposição de VD não parece influenciar os achados clínicos e radiográficos da saúde periimplantar. Palavras-chave: Densidade Óssea. Estudo Clínico. Implantação Dentária.

Investigating the Relationship the Severity of Coronary Artery Disease with Serum Levels of Vitamin D in Men after Eliminating the Effect of Diet

2020 ◽  
Vol 16 (4) ◽  
pp. 508-513
Author(s):  
Farshad K. Birgani ◽  
Majid M. Shahi ◽  
Bahman Cheraghian ◽  
Habib Haybar
Keyword(s):  
Coronary Artery Disease ◽  
Vitamin D ◽  
Coronary Artery ◽  
Serum Vitamin ◽  
Serum Levels ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
Artery Disease ◽  
The Relationship

Background: Coronary artery disease (CAD) is one of the most common cardiovascular diseases that can lead to mortality, inability, and lower productivity levels. Objective: The aim of this study was to determine the relationship between serum vitamin D level and cardiovascular risk factors and the severity of CAD after determining and eliminating the confounding effects of dietary patterns in male patients undergoing angiography. Methods: This descriptive-analytic study was carried out on 132 men undergoing angiography during 2017 and 2018. To this end, food frequency questionnaire (FFQ) and physical activity questionnaire (PAQ) were completed for the patients. Fasting blood sugar (FBS), triglyceride, total cholesterol, HDL-C, LDL-C and vitamin D levels were also investigated. Results: Serum vitamin D levels significantly decreased with an increase in CAD severity (p=0.001). Also, low serum levels led to the highest severity of CAD (p=0.005). However, there was no significant difference between patients with vitamin D deficiency with different degrees of CAD (p=0.084). Also, the highest percentage of individuals with normal serum levels of vitamin D was observed in the group without any blocked blood arteries (normal) (p=0.023). Conclusion: This study shows an inverse relationship between serum 25(OH) D level and the severity of CAD. Our data show that vitamin D plays an important role in preventing CAD. These findings could help design prospective studies and clinical trials on a wider scale to investigate the effects of vitamin D interventions in preventing the development of CAD.

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