Supplemental calcium and vitamin D and long-term mortality in aortic stenosis

Abstract

ObjectiveCalcium metabolism has long been implicated in aortic stenosis (AS). Studies assessing the long-term safety of oral calcium and/or vitamin D in AS are scarce yet imperative given the rising use among an elderly population prone to deficiency. We sought to identify the associations between supplemental calcium and vitamin D with mortality and progression of AS.MethodsIn this retrospective longitudinal study, patients aged ≥60 years with mild-moderate native AS were selected from the Cleveland Clinic Echocardiography Database from 2008 to 2016 and followed until 2018. Groups were stratified into no supplementation, supplementation with vitamin D alone and supplementation with calcium±vitamin D. The primary outcomes were mortality (all-cause, cardiovascular (CV) and non-CV) and aortic valve replacement (AVR), and the secondary outcome was AS progression by aortic valve area and peak/mean gradients.ResultsOf 2657 patients (mean age 74 years, 42% women) followed over a median duration of 69 months, 1292 (49%) did not supplement, 332 (12%) took vitamin D alone and 1033 (39%) supplemented with calcium±vitamin D. Calcium±vitamin D supplementation was associated with a significantly higher risk of all-cause mortality (absolute rate (AR)=43.0/1000 person-years; HR=1.31, 95% CI (1.07 to 1.62); p=0.009), CV mortality (AR=13.7/1000 person-years; HR=2.0, 95% CI (1.31 to 3.07); p=0.001) and AVR (AR=88.2/1000 person-years; HR=1.48, 95% CI (1.24 to 1.78); p<0.001). Any supplementation was not associated with longitudinal change in AS parameters in a linear mixed-effects model.ConclusionsSupplemental calcium with or without vitamin D is associated with lower survival and greater AVR in elderly patients with mild-moderate AS.

Increasing baseline aortic valve peak flow velocity is associated with progression of aortic valve stenosis in osteoporosis patients—a possible link to low vitamin D status

“…The serum level of 1,25(OH) 2 D is tightly regulated by PTH, and it reflects both endogenous production and the effect of activated vitamin D 3 analogs in this study [ 16 , 33 ]. The relationship between serum calcium levels and the progression of AS has not been conclusively established [ 34 , 35 ]. However, calcium supplementation, with or without native vitamin D, has been associated with a higher incidence of future aortic valve replacement in elderly patients with mild to moderate AS [ 35 ].…”

“…The relationship between serum calcium levels and the progression of AS has not been conclusively established [ 34 , 35 ]. However, calcium supplementation, with or without native vitamin D, has been associated with a higher incidence of future aortic valve replacement in elderly patients with mild to moderate AS [ 35 ]. Among the patients in this study, one out of three (case 7) who were taking activated vitamin D 3 analog experienced AS progression along with an increase in serum calcium levels exceeding 10.5 mg/dL [ 36 ].…”

Vitamin D and Cardiovascular Diseases: From Physiology to Pathophysiology and Outcomes

“…Findings from a small-scale study proposed a potential linear relationship between low levels of vitamin D and aortic valve peak flow velocity, as well as stenosis progression [114]. A retrospective study demonstrated significantly lower survival and a higher incidence of aortic valve replacement among patients receiving calcium supplements, with or without vitamin D, compared to those not receiving calcium [115]. Conversely, another study found phosphate, but not calcium or vitamin D, to be significantly related to aortic valve stenosis incidence [116].…”

Diagnosis and Management of Malnutrition in Patients with Heart Failure

“…Vitamin D deficiency tends to be common, although supplementation has not shown an improvement in quality of life, biochemical parameters, CV death, or hospitalization [1,38,41]. In some cases, calcium supplementation, alone or routinely combined with vitamin D, has been associated with decreased survival and an increased CV risk in older patients with mild-to-moderate aortic stenosis [48]. Therefore, the general recommendation would be to supplement only in cases of deficiency.…”