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While physical activity, weight reduction, and sensible sun exposure robustly increase 25(OH)D levels and powerfully reduce cardiovascular disease risk through direct mechanisms—such as improving endothelial function, lowering blood pressure, reducing systemic inflammation, and ameliorating metabolic profiles—the vitamin D elevation itself could be a secondary correlate of these behaviors, as suggested by the fundamental disconnect between observational studies and randomized trials: although low 25(OH)D is consistently associated with higher cardiovascular risk, direct vitamin D supplementation fails to replicate the significant cardiovascular benefits of the lifestyle interventions that raise it
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