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Impact of serum 25-hydroxyvitamin D on cardiac prognosis in Chinese patients with heart failure

  • Ya-Min Hou (a1), Jian-Ye Zhao (a1) and Hong-Yan Liu (a2)

Abstract

There is growing evidence that suggests the association of vitamin D status with the development and progression of heart failure (HF). The objective of the present study is to assess the impact of concentration of serum 25-hydroxyvitamin D (25(OH)D) on cardiac prognosis in patients with HF. Between 1 January 2015 and 31 December 2016, we consecutively recruited patients with HF. Patients were followed prospectively for a median duration of 1 year. Serum concentration of 25(OH)D was measured with competitive chemiluminescent immunoassay. The endpoints were cardiac events, including CVD death and rehospitalisation for worsening HF. Univariate and multivariable adjustments were performed with Cox proportional-hazard regression analyses. The 25(OH)D concentration was obtained in 343 patients with a median value of 17·4 (interquartile range 12·6–23·4) ng/ml. There were 102 cardiac events, including forty-three deaths and fifty-nine rehospitalisations. Multivariate Cox hazard analysis found that the serum concentration 25(OH)D was independently associated with cardiac events (hazard ratio 0·93, 95 % CI 0·88, 0·97) and CVD mortality (hazard ratio 0·83; 95 % CI 0·77, 0·89) after adjustment for confounding factors. We divided the HF patients into four groups according to the 25(OH)D quartiles. Kaplan–Meier analysis found that the patients with lower serum 25(OH)D concentration had a higher risk of cardiac events or CVD mortality than those with high serum 25(OH)D concentration (log-rank test P < 0·001 and P = 0·032). Decreased serum concentrations of 25(OH)D were associated with cardiac prognosis and CVD mortality in a Chinese population with HF independent of other baseline HF markers.

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Corresponding author

*Corresponding author: H.-Y. Liu, email niuuhfdd@126.com

References

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1.Zhang, Y, Zhang, J, Butler, J, et al. (2017) Contemporary epidemiology, management, and outcomes of patients hospitalized for heart failure in China: results from the China heart failure (China-HF) registry. J Card Fail 23, 868875.
2.National Center for Cardiovascular Diseases, China (2014) Report on Cardiovascular Diseases in China (2011), pp. 1–4 [HuShengshou, and KongLingzhi, , editors]. Beijing, China: Encyclopedia of China Publishing House.
3.Jiang, H & Ge, J (2009) The epidemiology and clinical management of cardiomyopathies and heart failure in China. Heart 95, 17271731.
4.Ariely, R, Evans, K & Mills, T (2013) Heart failure in China: a review of the literature. Drugs 73, 689701.
5.Jessup, M & Brozena, S (2003) Heart failure. New Engl J Med 348, 20072018.
6.Norman, PE, Powell, JT (2014) Vitamin D and cardiovascular disease. Circ Res 114, 379393.
7.Anderson, JL, May, HT, Horne, BD, et al. (2010) Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 106, 963968.
8.Agarwal, M, Phan, A, Willix, R, et al. (2011) Is vitamin D deficiency associated with heart failure? A review of current evidence. J Cardiovasc Pharmacol Ther 16, 354363.
9.Liu, CY, Voors, AA, van Veldhuisen, DJ, et al. (2011) Vitamin D status and outcomes in heart failure patients. Eur J Heart Fail 13, 619625.
10.Dobnig, H, Pilz, S, Scharnagl, H, et al. (2008) Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 168, 13401349.
11.Boxer, RS, Kenny, AM,Cheruvu, VK, et al. (2010) Serum 25-hydroxyvitamin D concentration is associated with functional capacity in older adults with heart failure. Am Heart J 160, 893899.
12.Zittermann, A, Schleithoff, SS, Gotting, C, et al. (2008) Poor outcome in end-stage heart failure patients with low circulating calcitriol levels. Eur J Heart Fail 10, 321327.
13.Meems, LM, Van der Harst, P, van Gilst, WH, et al. (2011) Vitamin D biology in heart failure: molecular mechanisms and systematic review. Curr Drug Targets 12, 2941.
14.Vacek, JL, Vanga, SR, Good, M, et al. (2012) Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol 109, 359363.
15.Gotsman, I, Shauer, A, Zwas, DR, et al. (2012) Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail 14, 357366.
16.Melamed, ML, Michos, ED, Post, W, et al. (2008) 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168, 16291637.
17.Heidari, B, Nargesi, AA, Hafezi-Nejad, N, et al. (2015) Assessment of serum 25-hydroxy vitamin D improves coronary heart disease risk stratification in patients with type 2 diabetes. Am Heart J 170, 573579.
18.Liu, L, Chen, M, Hankins, SR, et al. (2012) Serum 25-hydroxyvitamin D concentration and mortality from heart failure and cardiovascular disease, and premature mortality from all-cause in United States adults. Am J Cardiol 110, 834839.
19.Robinson-Cohen, C, Hoofnagle, AN, Ix, J H, et al. (2013) Racial differences in the association of serum 25-hydroxyvitamin D concentration with coronary heart disease events. JAMA 310, 179188.
20.Funayama, A, Shishido, T, Netsu, S, et al. (2011) Serum pregnancy-associated plasma protein A in patients with heart failure. J Card Fail 17, 819826.
21.Tu, WJ, Ma, GZ, Ni, Y, et al. (2017) Copeptin and NT-proBNP for prediction of all-cause and cardiovascular death in ischemic stroke. Neurology 88, 18991905.
22.Narumi, T, Watanabe, T, Kadowaki, S, et al. (2014) Impact of serum omentin-1 levels on cardiac prognosis in patients with heart failure. Cardiovasc Diabetol 13, 84.
23.Holick, MF (2007) Vitamin D deficiency. N Engl J Med 357, 266281.
24.Afarideh, M, Ghanbari, P, Noshad, S, et al. (2016) Raised serum 25-hydroxyvitamin D levels in patients with active diabetic foot ulcers. Br J Nutr 115, 19381946.
25.Whitley, E & Ball, J (2002) Statistics review 4: sample size calculations. Crit Care 6, 335341.
26.Schierbeck, LL, Jensen, TS, Bang, U, et al. (2011) Parathyroid hormone and vitamin D – markers for cardiovascular and all-cause mortality in heart failure. Eur J Heart Fail 13, 626632.
27.Tu, WJ, Zhao, SJ, Xu, DJ, et al. (2014) Serum 25-hydroxyvitamin D predicts the short-term outcomes of Chinese patients with acute ischaemic stroke. Clin Sci 126, 339346.
28.Dong, Y, Stallmann-Jorgensen, IS, Pollock, NK, et al. (2010) A 16-week randomized clinical trial of 2000 international units’ daily vitamin D3 supplementation in black youth: 25-hydroxyvitamin D, adiposity, and arterial stiffness. J Clin Endocrinol Metab 95, 45844591.
29.Kestenbaum, B, Katz, R, De Boer, I, et al. (2011) Vitamin D, parathyroid hormone, and cardiovascular events among older adults. J Am Coll Cardiol 58, 14331441.
30.Brøndum-Jacobsen, P, Benn, M, Jensen, GB, et al. (2012) 25-hydroxyvitamin D levels and risk of ischemic heart disease, myocardial infarction, and early death: population-based study and meta-analyses of 18 and 17 studies. Arterioscler Thromb Vasc Biol 32, 27942802.
31.Skaaby, T, Husemoen, LL, Pisinger, C, et al. (2012) Vitamin D status and cause-specific mortality: a general population study. PLOS ONE 7, e52423.
32.Cawthon, PM, Parimi, N, Barrett-Connor, E, et al. (2010) Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men. J Clin Endocrinol Metab 95, 46254634.
33.Gerling, ME, James, MT, Wilton, SB, et al. (2016) Serum total 25-OH vitamin D adds little prognostic value in patients undergoing coronary catheterization. J Am Heart Assoc 5, e004289.
34.Zhen, D, Liu, L, Guan, C, et al. (2015) High prevalence of vitamin D deficiency among middle-aged and elderly individuals in northwestern China: its relationship to osteoporosis and lifestyle factors. Bone 71, 16.
35.Ameri, P, Ronco, D, Casu, M, et al. (2010) High prevalence of vitamin D deficiency and its association with left ventricular dilation: an echocardiography study in elderly patients with chronic heart failure. Nutr Metab Cardiovasc Dis 20, 633640.
36.Cesari, M, Penninx, BW, Newman, AB, et al. (2003) Inflammatory markers and onset of cardiovascular events: results from the Health ABC study. Circulation 108, 23172322.
37.Boxer, RS, Dauser, DA, Walsh, SJ, et al. (2008) The association between vitamin D and inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc 56, 454461.
38.Selles, J, Bellido, T & Boland, R (1994) Modulation of calcium uptake in cultured cardiac muscle cells by 1,25-dihydroxyvitamin D3. J Mol Cell Cardiol 26, 15931599.
39.Beuckelmann, DJ, Nabauer, M & Erdmann, E (1992) Intracellular calcium handling in isolated ventricular myocytes from patients with terminal heart failure. Circulation 85, 10461055.
40.Xiang, W, Kong, J, Chen, S, et al. (2005) Cardiac hypertrophy in vitamin D receptor knockout mice: role of the systemic and cardiac renin–angiotensin systems. Am J Physiol Endocrinol Metab 288, E125E132.
41.Takeda, M, Yamashita, T, Sasaki, N, et al. (2010) Oral administration of an active form of vitamin D3 (calcitriol) decreases atherosclerosis in mice by inducing regulatory T cells and immature dendritic cells with tolerogenic functions. Arterioscler Thromb Vasc Biol 30, 24952503.
42.Tarcin, O, Yavuz, DG, Ozben, B, et al. (2009) Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metab 94, 40234030.
43.Shedeed, SA (2012) Vitamin D supplementation in infants with chronic congestive heart failure. Pediatr Cardiol 33, 713719.
44.Boxer, RS, Hoit, BD, Schmotzer, BJ, et al. (2014) The effect of vitamin d on aldosterone and health status in patients with heart failure. J Card Fail 20, 334342.
45.Moretti, HD, Colucci, VJ & Berry, BD (2017) Vitamin D3 repletion versus placebo as adjunctive treatment of heart failure patient quality of life and hormonal indices: a randomized, double-blind, placebo-controlled trial. BMC Cardiovasc Disord 17, 274.
46.D’Amore, C, Marsico, F, Parente, A, et al. (2017) Vitamin D deficiency and clinical outcome in patients with chronic heart failure: a review. Nutr Metab Cardiovasc Dis 27, 837849.
47.Jiang, WL, Gu, HB, Zhang, YF, et al. (2016) Vitamin D supplementation in the treatment of chronic heart failure: a meta-analysis of randomized controlled trials. Clin Cardiol 39, 5661.
48.Witham, MD, Crighton, LJ, Gillespie, ND, et al. (2010) The effects of vitamin D supplementation on physical function and quality of life in older patients with heart failure: a randomized controlled trial. Circ Heart Fail 3, 195201.
49.Cozzolino, M, Ketteler, M & Zehnder, D (2010) The vitamin D system: a crosstalk between the heart and kidney. Eur J Heart Fail 12, 10311041.

Keywords

Impact of serum 25-hydroxyvitamin D on cardiac prognosis in Chinese patients with heart failure

  • Ya-Min Hou (a1), Jian-Ye Zhao (a1) and Hong-Yan Liu (a2)

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