Finally, extravasation through the valvular endothelium seems to be an important step in the valvular lesions seen in RHD, and since s-25(OH)D regulates expression of vascular endothelial growth factor, this could explain the link between hypovitaminosis D and endothelial dysfunction, and subsequently ARF and RHD [14, 15]. Here, VEGFA is linked to rheumatic heart disease.