TNF and vitamin D deficiency: Vitamin D deficiency exerts anticoagulant effects by upregulating the expression of an anticoagulant glycoprotein (thrombomodulin) and downregulating the expression of a critical coagulation factor (tissue factor) in monocytes,[44] and increases itself the release of proinflammatory cytokines such as IL-6 and TNF-α [45] that may lead to a high MPV.[41] Consequently, high MPV, but also vitamin D deficiency per se, increases cardiac disease risk.