Vitamin D status and outcomes in heart failure patients

Abstract

AimsVitamin D status has been implicated in the pathophysiology of heart failure (HF). The aims of this study were to determine whether a low vitamin D status is associated with prognosis in HF and whether activation of the renin-angiotensin system (RAS) and inflammatory markers could explain this potential association. Methods and resultsWe measured 25-hydroxy-vitamin D (25(OH)D), plasma renin activity (PRA), interleukin-6 (IL-6), C-reactive protein (CRP), and the incidence of death or HF rehospitalization in 548 patients with HF. Median age was 74 (64 -80) years, left ventricular ejection fraction was 30% (23-42), and mean follow-up was 18 months. Low 25(OH)D levels were associated with female gender (P , 0.001), higher age (P ¼ 0.002), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (P , 0.001). Multivariable linear regression analysis showed that PRA (P ¼ 0.048), and CRP levels (P ¼ 0.006) were independent predictors of 25(OH)D levels. During follow-up, 155 patients died and 142 patients were rehospitalized. Kaplan -Meier analysis showed that lower 25(OH)D concentration was associated with an increased risk for the combined endpoint (all-cause mortality and HF rehospitalization; log rank test P ¼ 0.045) and increased risk for all-cause mortality (log rank test P ¼ 0.014). After adjustment in a multivariable Cox regression analysis, low 25(OH)D concentration remained independently associated with an increased risk for the combined endpoint [hazard ratio (HR) 1.09 per 10 nmol/L decrease; 95% confidence interval (CI) 1.00-1.16; P ¼ 0.040] and all-cause mortality (HR 1.10 per 10 nmol/L decrease; 95% CI 1.00-1.22; P ¼ 0.049). ConclusionA low 25(OH)D concentration is associated with a poor prognosis in HF patients. Activation of the RAS and inflammation may confer the adverse effects of low vitamin D levels.--

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. Our cohort study was prospectively designed to assess predictors of outcome in an unselected, consecutive group of patients with heart failure due to left ventricular systolic dysfunction on optimal contemporary medical and device therapy, and provides the strongest evidence to date that a low 25[OH]D concentration is an independent predictor of mortality.…”

“…Two-dimensional transthoracic echocardiography was performed in all participants by sonographers blinded to patient characteristics; left ventricular (LV) ejection fraction (LVEF) was calculated according to the Simpson's biplane method. Doses of diuretic therapy, angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and beta-blockers were normalised to maximum licensed CHF dose as previously described [10]. …”

“…Low serum 25-hydroxyvitamin D (25[OH]D) concentrations have been associated with an increased risk of adverse outcomes generally, [1,2] but especially in patients with suspected coronary artery disease, hypertension and chronic heart failure (CHF) [3][4][5][6][7][8][9][10]. However, published data pertaining to CHF are derived from registry data, or somewhat selected cohorts such as patients referred for coronary angiography, on a waiting list for cardiac transplantation or in-patients.…”

Could decreased vitamin D levels be related with impaired cardiac autonomic functions in patients with chronic heart failure: An observational study

“…Recent studies demonstrated the association of low vitamin D concentrations with cardiovascular events and all-cause mortality (4)(5)(6)22). However there are only two studies those showed the association of low levels of 25(OH) D and calcitriol level with sudden cardiac death (SCD) (7,8).…”

“…Inflammatory actions significantly increase with poor vitamin D status . Vitamin D metabolites have direct effects on cardiomyocytes including anti-hypertrophic actions, regulation of extracellular matrix turnover, and modulation of contractility (4)(5)(6). In addition vitamin D insufficiency has effect on HF prognosis.…”