1,25-Dihydroxyvitamin D to PTH(1–84) Ratios Strongly Predict Cardiovascular Death in Heart Failure

Abstract

ObjectivesVitamin D deficiency and hyperparathyroidism are common in patients with heart failure (HF). There is a growing body of evidence supporting the role of vitamin D and parathyroid hormone (PTH) in cardiac remodeling and worsening of HF. Lack of reliable automated testing of 1,25-dihydroxyvitamin D (1,25(OH)2D), the biologically active metabolite of vitamin D, has limited its contribution to the prognostic assessment of HF. Here, the association of 1,25(OH)2D and PTH(1–84) levels was evaluated for prediction of cardiovascular death in chronic HF patients.MethodsWe conducted a single center prospective cohort including 170 chronic HF patients (females n = 36; males n = 134; NYHA II-IV; mean age: 67 years; etiology: ischemic n = 119, dilated cardiomyopathy n = 51; mean LVEF: 23%). The primary outcome was cardiovascular death.ResultsSerum levels of 1,25(OH)2D decreased markedly with increased HF severity. Medians were 33.3 pg/mL for NYHA-II patients, 23.4 pg/mL for NYHA-III, and 14.0 pg/mL for NYHA-IV patients (p<0.001). Most patients had levels of 25(OH)D below 30ng/mL, and stratification by NYHA functional class did not show significant differences (p = 0.249). The 1,25(OH)2D to PTH(1–84) ratio and the (1,25(OH)2D)2 to PTH(1–84) ratio were found to be the most significantly related to HF severity. After a median follow-up of 4.1 years, 106 out of 170 patients reached the primary endpoint. Cox proportional hazard modeling revealed 1,25(OH)2D and the 1,25(OH)2D to PTH(1–84) ratios to be strongly predictive of outcomes.Conclusions1,25(OH)2D and its ratios to PTH(1–84) strongly and independently predict cardiovascular mortality in chronic HF.

Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure

“…After adjusting for multiple confounders, the outcome data from the cohort study are consistent with previous smaller reports in ambulatory patients [9,21,22], hospitalised patients [10] and registry data [3,6,23], and reveal increased mortality in patients with low 25[OH]D concentrations compared with those without. In all of these previous studies, 25[OH]D deficiency was less frequent than in our cohort ranging from 28 to 75% [10,24], whilst overall mortality of the cohorts was higher.…”

Role of Vitamin D in Cardiovascular Diseases

“…Improvement in clinical symptoms after vitamin D and calcium supplementation for the treatment of hypovitaminosis and hypocalcemia signifies the importance and protective role of vitamin D in cardiomyopathy [9–10, 34–39] (Table 1). Gruson et al [40] suggested that serum 1,25(OH) 2 D 3 and its ratio to parathyroid hormone (PTH) (1–84) strongly and independently predict cardiovascular mortality in chronic HF. Additionally, Leon Rodriguez et al [41] suggested that vitamin D receptor (VDR) polymorphisms may also be a risk factor for increased susceptibility for cardiomyopathy and reported the increased probability of cardiac complications such as chronic Chagas cardiomyopathy with rs2228570*A VDR allele due to impaired immune response against T. cruzi .…”

Calciotropic and Phosphaturic Hormones in End-Stage Heart Failure Patients Supported by a Left-Ventricular Assist Device

“…Our data demonstrate that end-stage heart failure patients have very high FGF-23 values and very low 1,25(OH) 2 D levels before and after LVAD implantation. We [9,11] and others [8,10,12] have already reported that elevated FGF-23 levels and low 1,25(OH) 2 D levels are both independently associated with poor clinical outcome in HF patients.…”