# Exploring Vitamin D Synthesis and Function in Cardiovascular Health: A Narrative Review
## 5 Impact of Dietary Vitamin D Fortification on Blood Vitamin D Levels and Cardiovascular Outcomes
For instance, in Finland, despite the rise in 25(OH)D levels due to mandatory fortification, the expected decline in cardiovascular incidents has not been conclusively observed, suggesting that other factors like dietary patterns, genetic predispositions, and lifestyle choices play significant roles [81]. Studies often show that micronutrient enhancements improve markers of general health but fail to demonstrate efficacy in preventing complex conditions such as heart disease, which involve multifactorial etiologies beyond simple nutritional deficiencies. This highlights the need for integrated health strategies that go beyond nutritional fortification, incorporating public health initiatives aimed at overall lifestyle and environmental changes to effectively combat cardiovascular diseases [92]. Table 2 synthesizes in vivo studies on the impact of Vitamin D-fortified foods, drawn from systematic reviews and meta-analysis of randomized trials. Based on the variability of results observed in current studies, policy recommendations should consider more localized fortification strategies that take into account regional dietary patterns, sunlight exposure, and genetic factors that may influence Vitamin D metabolism. Adapting policies to regional health profiles could improve the effectiveness of fortification in preventing cardiovascular disease and other complex health conditions [93]. Continued research is essential to better understand the differential impacts of Vitamin D2 and D3, as well as the optimal levels of fortification needed to influence public health outcomes positively. This should include long-term studies that not only assess biochemical markers but also directly correlate these with reductions in disease incidence, particularly in diverse population groups [94]. \begin{table}
\begin{tabular}{c c c c c c} \hline \hline \multirow{2}{*}{**Year**} & \multicolumn{1}{c}{**Outcome**} & \multirow{2}{*}{**Summary**} & \multirow{2}{*}{**Foods Included**} & \multirow{2}{*}{**Main Findings**} & \multirow{2}{*}{**Refs.**} \\  & **Measured** & & & & & \\ \hline \multirow{6}{*}{2008} & \multirow{6}{*}{Improvement in Vitamin D status.} & Discusses Vitamin D’s & \multirow{6}{*}{Fortified milk,} & \multirow{6}{*}{Food fortification with cheese,} & \multirow{6}{*}{Vitamin D effectively improves Vitamin D status in adults.} \\  & & health benefits and the effectiveness of fortified & & & \\  & & foods in increasing Vitamin & & & \\  & & D levels, and calls for & & products, orange & \\  & & stronger data on food & & juice, bread. & \\  & & & fortification. & & \\ \hline \multirow{6}{*}{2012} & \multirow{6}{*}{Rise in circulating Vitamin D levels.} & Examines Vitamin D food & \multirow{6}{*}{Milk, yogurt,} & \multirow{6}{*}{Dose-dependent increase in 25(OH)D levels observed with} \\  & & fortification’s success in raising 25(OH)D levels in & & & \\  & & a adults and stresses the need & & & \\  & & for high-quality research & & & \\  & & and reporting. & & & \\ \hline \multirow{6}{*}{2019} & Improvements in Vitamin D status & Reports Vitamin D-fortified & \multirow{6}{*}{Yogurt, milk,} & \multirow{6}{*}{Fortified yogurt raises serum 25 OHD and} \\  & Vitamin D status & yogurt’s potential in & & & \\  & and metabolic & improving health outcomes & & & \\  & health markers. & across various populations. & & & \\ \hline \hline \end{tabular}
\end{table} 
Table 2: In vivo studies on the impact of Vitamin D-fortified food. \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline