CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 6, November/December 2010
AFRICA
348
Your Life and Your Heart
Vitamin D is a prognostic marker in heart failure
A Dutch study of vitamin D levels in
patients with heart failure, presented at
the 2010 European Society of Cardiology
(ESC) congress in Stockholm, provoked
considerable interest among cardiolo-
gists as it suggests that they advise their
patients to maintain appropriate vitamin
D levels.
1
Liu and co-workers at the University
Medical Centre, Groningen, Netherlands
showed that:
•
a low vitamin D concentration is asso-
ciated with a poor prognosis in heart
failure
•
the correlation found between vita-
min D, plasma renin activity and
C-reactive protein suggests that an
activated renin–angiotensin system
and an altered cytokine profile may
play an important role in the asso-
ciation between vitamin D and heart
failure.
In this study, 548 patients hospitalised
due to heart failure were studied, and
the correlation was examined between
25-hydroxy vitamin D (nmol/l) levels,
plasma renin activity (PRA), the presence
of inflammatory cytokines, and the inci-
dence of death or heart failure re-hospi-
talisations during the 18-month follow up.
The mean age was 71 years and mean
left ventricular ejection fraction was 33
±
14%. Patients were grouped into tertiles
according to vitamin D levels (T1:
<
29.6; T2: 29.6–43.9; T3:
>
43.9 nmol/l).
Vitamin D levels were higher in males (
p
<
0.001) and younger patients (
p
=
0.002),
and those with lower galectin-3 (
p
<
0.001) and NT-proBNP levels (
p
<
0.001).
Multivariate linear regression analy-
sis showed that plasma renin activity (
p
=
0.003) and C-reactive protein (CRP)
levels (
p
=
0.002) are independent predic-
tors of vitamin D levels. During follow
up, 165 patients died and 142 were
re-hospitalised. Kaplan-Meier analysis
showed that lower vitamin D concentra-
tion was associated with an increased
risk for all-cause mortality (log rank
test,
p
=
0.014) and increased risk for the
combined endpoint (mortality and heart
failure re-hospitalisation; log rank test,
p
=
0.045).
Importantly, after adjustment in a
multivariable Cox regression analysis,
high vitamin D concentration remained
independently associated with a decreased
risk for all-cause mortality (HR: 0.66;
95% CI: 0.44–0.99;
p
=
0.044) and the
combined endpoint (HR: 0.69; 95% CI:
0.51–0.95;
p
=
0.022).
The results of this study provide
compelling evidence that a high vitamin
D status is associated with improved
survival in heart failure patients. ‘It seems
that physicians should advise their heart
failure patients to maintain their vitamin
D levels by taking supplements, eating
oily fish or eggs or ensuring exposure to
sunlight’, Ms Liu conluded.
J Aalbers, Special Assignments Editor
1. Liu LCY,
et al
. Prognostic value of vitamin D
in heart failure. P 5675, ESC 2010 Congress.
Eur Heart J
2010;
31
: 1054.
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