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motor coach tour companies coronary heart disease or non fatal heart attack which was diagnosed in the 9 to 11 year period between the time of blood sample collection through January, 2004.Adjusted analysis of the data found a 2.42 times greater risk of heart attack among subjects with plasma vitamin D levels of 15 nanograms per milliliter or less compared with those whose levels were sufficient at 30 nanograms per milliliter or higher. Even those men whose vitamin D levels fell in an "intermediate range" had a 43 to 60 percent greater risk of heart attack compared to men with sufficient levels. Adjustment for a number of factors, such as family history of heart attack, failed to significantly reduce the association. Men with low levels of vitamin D were more likely to live in northern states (where there is less exposure to the sun, especially during winter months), and less likely to be white or to use a multivitamin supplement, among other characteristics revealed by the analysis. Vitamin D as an anti inflammatory agent showing benefit in cardiovascular disease is a possible mechanism of benefit, as cardiovascular disease has been linked in the past to inflammation and inflammatory markers such as C reactive protein, a protein often present when inflammation is present in the body. Other potential mechanisms include protection against type 2 diabetes, inflammation, and seasonal respiratory tract infections (especially influenza), all of which can impact cardiovascular disease mortality. "If this association is causal, which remains to be established, the amount of vitamin D required for optimal benefit may be much