Effects of Vitamin D on Cardiac Function in Patients With Chronic HF

Abstract

BackgroundPatients with chronic heart failure (HF) secondary to left ventricular systolic dysfunction (LVSD) are frequently deficient in vitamin D. Low vitamin D levels are associated with a worse prognosis.ObjectivesThe VINDICATE (VitamIN D treatIng patients with Chronic heArT failurE) study was undertaken to establish safety and efficacy of high-dose 25 (OH) vitamin D3 (cholecalciferol) supplementation in patients with chronic HF due to LVSD.MethodsWe enrolled 229 patients (179 men) with chronic HF due to LVSD and vitamin D deficiency (cholecalciferol <50 nmol/l [<20 ng/ml]). Participants were allocated to 1 year of vitamin D3 supplementation (4,000 IU [100 μg] daily) or matching non−calcium-based placebo. The primary endpoint was change in 6-minute walk distance between baseline and 12 months. Secondary endpoints included change in LV ejection fraction at 1 year, and safety measures of renal function and serum calcium concentration assessed every 3 months.ResultsOne year of high-dose vitamin D3 supplementation did not improve 6-min walk distance at 1 year, but was associated with a significant improvement in cardiac function (LV ejection fraction +6.07% [95% confidence interval (CI): 3.20 to 8.95; p < 0.0001]); and a reversal of LV remodeling (LV end diastolic diameter -2.49 mm [95% CI: -4.09 to -0.90; p = 0.002] and LV end systolic diameter -2.09 mm [95% CI: -4.11 to -0.06 p = 0.043]).ConclusionsOne year of 100 μg daily vitamin D3 supplementation does not improve 6-min walk distance but has beneficial effects on LV structure and function in patients on contemporary optimal medical therapy. Further studies are necessary to determine whether these translate to improvements in outcomes. (VitamIN D Treating patIents With Chronic heArT failurE [VINDICATE]; NCT01619891)

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

“…Moreover, the median age of participants was 54yrs, with an unusually high (80%) device therapy rate, the study included people who were sufficient in 25[OH] D (concentrations 50-75 mmol/L) and the group assigned vitamin D supplementation had significantly worse renal function and was 2 years older. In contrast, participants in our two studies and the present cohort study were ambulant outpatients, mean age 70 years with a more typical device therapy rate (30%) and all had 25[OH]D concentrations < 50 nmol/L [12].…”

“…Vitamin D has multiple effects throughout the body that may be of particular relevance in people with CHF [11]. We have recently described in a randomised, placebo-controlled trial in unselected ambulatory patients with CHF and 25 [OH]D deficiency that vitamin D 3 supplementation (100 mcg (4000 IU) daily) improves left ventricular structure and function [12]. Whether 25[OH]D deficiency independently predicts outcomes in unselected patients with CHF remains unclear.…”

Role of Vitamin D in Cardiovascular Diseases

“…Fok1) gene [85–89]. Improvement and beneficial effects of vitamin D on LV structure and function in the VINDICATE (VitamIN D treatIng patients with Chronic heArT failurE) study in HF [90] and decreased renin activity with short-term vitamin D supplementation in chronic HF patients [91] suggest the therapeutic role of vitamin D (Table 1). …”

Vitamin D and acute myocardial infarction

“…Yet, it has been recently demonstrated that high-dose vitamin D supplementation for 1-year in patients with chronic heart failure due to left ventricular systolic dysfunction and vitamin D deficiency, on contemporary optimal medical therapy, resulted in a significant improvement in left ventricular structure and function[59]. Of note, in almost 60% of these patients, the etiology was ischemic heart disease, suggesting a possible beneficial effect on post-AMI ventricular dysfunction[59]. …”