A recent study examines if a high-dose vitamin D3 supplement could replenish vitamin D stores in deficient heart failure patients.
Roughly 600,000 Canadians currently live with heart failure and 50,000 new cases are diagnosed each year. The cost of the disease burden amounts to $2.8 billion annually.1 Prognosis is generally poor with an average one-year mortality rate of 33%.2 Numerous studies indicate that a vitamin D deficiency in patients with heart failure can significantly increase the risk of morbidity and mortality, including from sudden cardiac death.3,4
Adequate clinical data on the effects of a vitamin D3 supplement in heart failure patients are not available, especially on quality of life (QOL) indices and exercise cardiopulmonary status (CPX). Both the QOL index and CPX are good prognostic markers of mortality and morbidity in heart failure patients. A recent study attempted to monitor the effects of a vitamin D3 supplement on these markers in heart failure patients. The results of the study were published in a recent issue of BMC Cardiovascular Disorders.5
The study recruited 40 patients who were older than 18 years old and suffered from heart failure of either Class II or Class III, as defined by the New York Heart Association (NYHA). These patients were stable under medical therapy and had a 25(OH)D level of less than 32 ng/ml. 25(OH)D is a prehormone produced from vitamin D3 in the liver, which is subsequently converted to the active hormone calcitriol.
Quality of life indices, cardiopulmonary exercise data, and lab test data were collected from these patients. They were then randomly divided into two groups: one receiving vitamin D3 supplementation at 10,000 units/day and the other receiving a placebo for a period of six months.
The patients underwent clinical tests at baseline and after six months. Apart from 25(OH)D, the serum levels of the b-type natriuretic peptide (BNP), parathyroid hormone (PTH), and high sensitivity C-reactive protein (hsCRP), complete blood counts, and a complete metabolic panel were determined. BNP is a hormone released by the heart in response to pressure changes inside the heart, with higher levels observed in patients with heart failure. Similarly, high circulating levels of parathyroid hormone, which elevates blood calcium levels, is associated with an increased risk for heart failure. hsCRP is a measure of systemic inflammation, which may indicate an increased risk of heart attacks, stroke, and sudden cardiac death.
Analysis of the clinical data showed that while 25(OH)D levels rose by about 49 ng/ml in the vitamin D3 supplementation group, they rose by 4 only ng/ml in the placebo group. BNP levels rose by a mere 30 pg/ml in the vitamin D3 group but by 400 pg/ml in the placebo group. While PTH levels were reduced by vitamin D3 supplementation, the reduction was not significant when adjusted to baseline 25(OH)D levels. The levels of hsCRP declined with vitamin D3 supplementation in men but remained unchanged in women. Other cardiopulmonary function indices remained unchanged. Importantly, quality of life scores improved significantly in the vitamin D3 group.
Overall, these results suggest that taking a vitamin D3 supplement may decrease the levels of the heart failure biomarker BNP and improve the overall quality of life in heart failure patients. However, the paper’s authors emphasize the importance of further research to determine the effects of vitamin D on cardiovascular death, hospitalizations, and all-cause mortality. They also indicate that further research may be required to determine if supplementing with nutrients that enhance vitamin D efficacy would improve outcomes in heart failure patients.
Written by Usha B. Nair, Ph.D.
(1) Heart and Stroke Foundation. 2016 Report of the Health of Canadians: The burden of heart failure. http://www.heartandstroke.ca/-/media/pdf-files/canada/2017-heart-month/heartandstroke-reportonhealth-2016.ashx?la=en; Accessed: November 10, 2017.(2) Lee DS, Johansen H, Gong Y, Hall RE, Tu JV, Cox JL. Canadian Cardiovascular Outcomes Research Team. Regional outcomes of heart failure in Canada. Can J Cardiol. 2004 May 1;20(6):599-607. PubMed PMID: 15152289.
(3) Pilz S, März W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, Boehm BO, Dobnig H. Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab. 2008 Oct;93(10):3927-35. doi: 10.1210/jc.2008-0784. Epub 2008 Aug 5. PubMed PMID: 18682515.
(4) Ameri P, Ronco D, Casu M, Denegri A, Bovio M, Menoni S, Ferone D, Murialdo G. 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. 2010 Nov;20(9):633-40. doi: 10.1016/j.numecd.2010.01.002. Epub 2010 Apr 15. PubMed PMID: 20399085.
(5) Moretti HD, Colucci VJ, Berry BD. 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. 2017 Oct 30;17(1):274. doi: 10.1186/s12872-017-0707-y. PubMed PMID: 29084522; PubMed Central PMCID: PMC5663043.