关于维生素D补充对心脏代谢危险因素的影响，现有研究结果仍没有一致结论。主要原因在于，已报道的研究结果中存在较大异质性，因此需要进一步研究以识别异质性的来源和潜在的效应修饰因素。本研究进行了一项系统综述与荟萃分析，纳入了截至2024年3月发布的随机对照试验（RCT），这些试验报告了维生素D补充对心脏代谢危险因素影响的效应估计值及参与者的相关基线协变量。对99项RCT的17 656名参与者进行分析，使用随机效应模型计算干预组相对于对照组的加权平均值差异及95%置信区间（CI）。总体而言，与安慰剂相比，维生素D补充[剂量中位数为3320国际单位（IU）∙d^-1；剂量范围40~120 000 IU∙d^-1）对收缩压[SBP；-2.04（95% CI，-3.50，-0.59）mmHg；1 mmHg = 0.133 kPa]、舒张压[DBP；-3.00（95% CI，-3.61，-2.39）mmHg]、总胆固醇[TC；-0.12（95% CI，-0.21，-0.03）mmol∙L^-1]、空腹血糖[FBG；-0.13（95% CI，-0.20，-0.05）mmol∙L^-1]、糖化血红蛋白[A1C；-0.09%（95% CI，-0.13%，-0.05%）]和空腹血胰岛素[FBI；-7.61（95% CI，-11.93，-3.30）pmol∙L^-1]均具有积极效果。维生素D的益处在非西方人群、基线25-羟基维生素D（25[OH]D）低于15.0 ng∙mL^-1、非肥胖[体重指数（BMI） < 30 kg∙m^-2]和年纪较大（年龄≥50岁）的参与者中最为显著。本研究的结果强调了制定个性化维生素D干预策略的必要性，需全面考虑个体特征（如民族文化背景、年龄、BMI和外周循环25[OH]D水平）、干预剂量和干预持续时间，以改善心脏代谢健康结局。

The inconsistent findings concerning the effects of vitamin D supplementation on cardiometabolic risk factors and the large heterogeneity in the published literature call for further research to identify sources of heterogeneity and potential effect modifiers. We performed a meta-analysis of randomized controlled trials (RCTs) published until March 2024 that reported estimates for the effects of vitamin D supplementation on cardiometabolic factors and relevant baseline covariates of RCT participants. A total of 17 656 participants from 99 RCTs were analyzed, and weighted mean differences (95% confidence intervals (CI)) for the intervention status were derived using random-effects modeling. Overall, compared with the placebo, vitamin D supplementation (median dose: 3320 international unit (IU)·day⁻¹; range 40-120 000 IU·day⁻¹) had favorable effects on systolic blood pressure (SBP; −2.04 (95% CI, −3.50, −0.59) mmHg; 1 mmHg = 0.133 kPa), diastolic blood pressure (DBP; −3.00 (95% CI, −3.61, −2.39) mmHg), total cholesterol (TC; −0.12 (95% CI, −0.21, −0.03) mmol·L⁻¹), fasting blood glucose (FBG; −0.13 (95% CI, −0.20, −0.05) mmol·L⁻¹), hemoglobin A1C (A1C; −0.09% (95% CI, −0.13%, −0.05%)), and fasting blood insulin (FBI: −7.61 (95% CI, −11.93, −3.30) pmol·L⁻¹). The benefits of vitamin D were most evident in trials performed in non-Westerners, participants with baseline 25-hydroxyvitamin D (25[OH]D) lower than 15.0 ng·mL⁻¹, non-obese (body mass index (BMI) < 30 kg·m⁻²), and older (age ≥ 50 years). The findings of this study underscore the need for personalized vitamin D intervention strategies that comprehensively account for individual patient characteristics (such as ethnocultural background, age, BMI, and circulating 25[OH]D level), intervention dosage, and intervention duration to optimize cardiometabolic health outcomes.