Is Vitamin D Deficiency Associated With Heart Failure? A Review of Current Evidence.

J Cardiovasc Pharmacol Ther. 2011 Feb 8.
Agarwal M, Phan A, Willix R Jr, Barber M, Schwarz ER.
Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA.

An estimated 1 billion people worldwide have deficient or insufficient levels of vitamin D. Even more alarming is the association of vitamin D deficiency with many types of diseases, particularly heart failure (HF). Hypovitaminosis D has been observed to be highly prevalent in the HF community with rates varying from approximately 80% to 95%. Higher rates of deficiency have been linked to winter months, in patients with protracted decompensated HF, darker skin pigmentation, and higher New York Heart Association (NYHA) classes.

In fact, some data suggest vitamin D deficiency may even be an independent predictor of mortality in patients with HF. Traditionally obtained through UV exposure and activated in the liver and then the kidneys, vitamin D is classified as a vitamin but functions as a steroid hormone. The hormone acts through the vitamin D receptor (VDR), which is expressed in vascular smooth muscle cells, renal juxtaglomerular cells, and most interestingly, cardiac myocytes. Studies have shown that the association between vitamin D deficiency and HF often manifests in the structural components of cardiac myocytes and/or through alterations of the neurohormonal cascade.

In addition, vitamin D may also act rapidly through intracellular nongenomic receptors that alter cardiac contractility. Unfortunately, prospective vitamin D supplementation trials show mixed results. In rat models, successful correction of deficiency was associated with reductions in ventricular hypertrophy. In humans, however, echocardiographic dimensions did not change significantly.

These results bring into questions whether vitamin D is

• A risk factor for HF,
• a marker of HF disease severity, or has
• a true pathologic role.

This article provides a thorough review of vitamin D deficiency etiology, prevalence, and possible pathophysiologic role in HF. Furthermore, we carefully review prospective trials on vitamin D therapy in HF. We believe more trials on vitamin D therapy in HF need to be conducted before any conclusions can be drawn.

PMID: 21304056
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See also Vitamin D Life

• Overview Cardiovascular and vitamin D
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• Lack of vitamin D is a predictor of heart failure – Sept 2010
• Review of vitamin D and heart failure – Aug 2010
• Vitamin D and cardiovascular disease - Systematic review June 2010
• Cardiovascular Systematic Review of Vitamin D- Mar 2010
• Question - Does more vitamin D make veins less stiff - Nov 2007
• Vitamin D less than 15 ng did not predict additional cardiovascular disease events – June 2010
• Low Vitamin D associated with cardiovascular disease – June 2010
• Meta-analysis unsure if vitamin D can prevent cardiovascular disease – Sept 2010 levels not stated in abstract
• Vitamin D reduces both death rate and cardiovascular disease – Sept 2010
• Vitamin D is important for cardiovascular health – Sept 2010 nice chart and tables
• Cardiology diseases highly associated with low vitamin D – Oct 2010 based on 41,000 patients
• Review of heart failure and vitamin D mechanisms – Jan 2011
• Why we need large-scale heart trials of vitamin D - Dec 2010
• OVERVIEW of strokes
• All items in Cardiovascular and vitamin D
• Overview Cardiovascular and vitamin D
• Increasing vitamin D levels will probably reduce CVD and mortality – June 2011
• Heart patients 10 percent more likely to die for every 4 ng less vitamin D – May 2011
• Lack of vitamin D associated with many cadiovascular problems – May 2011
• Heart Failure associated with vitamin D deficiency – Feb 2011
• 96 percent of heart failure patients had less than 30 ng of vitamin D – March 2011