Effect of Vitamin D in the Prevention of Myocardial Injury Following Elective Percutaneous Coronary Intervention: A Pilot Randomized Clinical Trial

Abstract

Myocardial injury following elective percutaneous coronary intervention (PCI) occurs in about one-third of patients and is associated with mortality. Platelet aggregation, thrombosis formation, and inflammation are the main causes of cardiac injury during PCI. Vitamin D plays a key role in the cardiovascular system by exerting antiplatelet, anticoagulant, and anti-inflammatory properties. There is no published study that investigated the effect of vitamin D in the prevention of cardiac injury following elective PCI. In a randomized clinical trial, 99 patients admitted for elective PCI were randomized into vitamin D (n = 52) and control (n = 47) groups. The intervention group received 300 000 IU vitamin D orally 12 hours before PCI. The cardiac biomarkers were checked at baseline, 8 and 24 hours after PCI. hs-CRP was also measured at baseline and after 24 hours. The increase in CK-MB was documented in 20 patients (42%) in the control group and 18 patients (34.6%) in the intervention group (P = .417). Furthermore, the increase in cTnI occurred in 4 patients (8%) and 2 patients (3.3%) in the control and intervention groups, respectively (P = .419). No significant changes were noted in the level of cardiac biomarkers. In the vitamin D group, the mean difference in CK-MB between 8 and 24 hours was significantly lower (P = .048). The mean difference in hs-CRP was significantly lower in the vitamin D group (P = .045). This study could not show a clear effect of vitamin D in the prevention of cardiac injury during elective PCI. Further outcome-based studies are needed to describe the role of vitamin D in the prevention of periprocedural myocardial injury.

Vitamin D Deficiency is Associated With Higher Level of High Sensitivity C-reactive Protein (Hs-crp) in Patients Undergoing Elective Coronary Stenting

“…hours in vitamin D groups. (26) Reports of this trial in addition to ours substantiate our hypothesis about the negative impact of vitamin D de ciency on PCI outcome through masking its anti-in ammatory effect, with emphasis on hs-CRP, in these patients.…”

Potential Beneficial Effects of Vitamin D in Coronary Artery Disease

“…One consideration worth following with this study design is the bioavailability of vitamin D. A high-dose intervention with a long dosage interval might be a suboptimal study design [90]. All RCTs that used this study design failed to demonstrate major benefits of vitamin D supplementation, even though plasma levels were restored [75,79,80,82,86].…”

Vitamin D Determinants, Status, and Antioxidant/Anti-inflammatory-Related Effects in Cardiovascular Risk and Disease: Not the Last Word in the Controversy

“…Some data suggested that vitamin D may reduce or prevent the disease progression and cardiovascular risk in T2D patients by decreasing oxidative stress and platelet-mediated inflammation (IL-18, TNF-α, IFN-γ, CXCL-10, CXCL-12, CCL-2, CCL-5, CCL-11, and PF-4), as well as blood vitamin D supplementation (2000 IU/day for six months) in T2D patients having vitamin D < 20 ng/mL resulted associated to a significant decrease in OxLDL, hsCRP, IL-6, PAI-1, and fibrinogen levels and a significant increase in FRAP, (although other studies failed to evidence any significant effect on different biomarkers of oxidative stress and inflammation in these type of patients) [ 191 , 192 , 193 , 194 ]. Furthermore, in patients with CAD, there are controversial data on the effects of vitamin D supplementation on oxidative or inflammatory biomarkers related to cardiovascular health [ 195 , 196 , 197 ]. A recent meta-analysis aiming to assess the effect of vitamin D supplementation on cardiac outcomes in patients with CAD did not evidence any significant effects on hs-CRP mean difference (−0.04, p = 0.25), although included a limited number of studies, with small sample size and short duration of interventions [ 198 ].…”