Effects of Atorvastatin on Vitamin D Levels in Patients With Acute Ischemic Heart Disease

Abstract

Vitamin D deficiency is a risk factor for osteoporosis and other chronic diseases, including type 1 diabetes, hypertension, metabolic syndrome, and ischemic heart disease. Cholesterol and vitamin D share the 7-dehydrocolesterol metabolic pathway. This study evaluated the possible effect of atorvastatin on vitamin D levels in patients with acute ischemic heart disease. Eighty-three patients (52 men and 31 women) with an acute coronary syndrome (75 with acute myocardial infarction and 8 with unstable angina) were included. After diagnosis, patients received atorvastatin as secondary prevention. Serum vitamin D was measured by high-performance liquid chromatography at baseline and at 12 months. Atorvastatin treatment produced a statistically significant decrease in cholesterol and triglyceride levels and an increase in vitamin D levels ( Vitamin D deficiency is a risk factor for osteoporosis and other chronic diseases, including type 1 diabetes, hypertension, metabolic syndrome, and ischemic heart disease. 1 Vitamin D is synthesized in the skin by ultraviolet radiation that acts on 7-dehydrocolesterol, which is hydroxylated into carbon-25 by 25-hydroxyvitamin D-1␣ hydroxylase or CYP27B1, an enzyme located in the mitochondria of the hepatocyte. The resulting metabolite, 25-hydroxyvitamin D, is the best way to measure individual vitamin D levels. 2 Cholesterol and vitamin D share the 7-dehydrocolesterol metabolic pathway. 3 Statins have beneficial effects on morbidity and mortality of patients with acute ischemic heart disease; these may be mediated by vitamin D. These patients have a greater prevalence of vitamin D deficiency and are often treated with statins as secondary prevention. 1 This led us to study the possible effect of atorvastatin on vitamin D levels in this group of patients. Increased levels of vitamin D could explain some of the beneficial effects of atorvastatin at the cardiovascular and bone metabolism levels that are unrelated to cholesterol levels. Methods and ResultsPatients hospitalized for an acute coronary syndrome, defined as high-risk unstable angina, non-ST-elevated myocardial infarction, or ST-elevated myocardial infarction, were eligible for inclusion. Eighty-three patients (52 men and 31 women) with an acute coronary syndrome (75 with acute myocardial infarction and 8 with unstable angina) were included. Patients were recruited at hospital admission. Exclusion criteria were alcoholism, neoplasia, hyperor hypocalcemia, and treatment with phosphocalcium metabolism-modifying drugs. After diagnosis, patients received atorvastatin as secondary prevention. Low (10 to 20 mg) and high (40 to 80 mg) doses were used according to baseline levels of cholesterol and triglycerides and index of vascular risk. Only patients completing follow-up were evaluated. A control group of 73 hypertensive patients (38 men and 35 women) not receiving treatment with statins was included.Blood samples were obtained after 8 or 9 hours of fasting. Total calcium, phosphorus, total cholesterol, and triglycerides were mea...

A Deficiência de vitamina d está associada com níveis aumentados de il-17 e tnfα em pacientes com insuficiência cardíaca crônica

“…However, these levels remained insufficient (data not shown). This finding supports several previous reports which suggested that statins may increase the synthesis of calcitriol by inducing enzyme 7-dechydrocholesterol 23,24 .…”

A Cross-Sectional Study of the Association between Circulating 25-Hydroxyvitamin D Levels and Predicted Operative Mortality of Patients with Cardiovascular Disease

“…As a result, however, we did not include iCa as a confounder in multiple linear regression analyses, because EuroSCORE was not signifi cantly correlated with iCa in simple linear regression analysis. Additionally, we included statin therapy as a covariate, because statin therapy has been shown to increase circulating vitamin D levels (20) and may be a confounder behind the negative association between 25OHD as well as 1,25OHD levels, and Euro-SCORE (21). In contrast, we did not use underlying diseases (i.e., CAD, VHD and AD) as confounders because EuroSCORE already accounts for these operation-related factors.…”

Statins and Vitamin D

“…They demonstrate that rosuvastatin increases the blood level of vitamin D as 25-hydroxyvitamin D and also the activated hormone 1,25-dihydroxyvitamin D. This effect has also been found with atorvastatin [18]. The mechanism is unexplained and is far from clear.…”