Vitamine D improves heart function in course of chronic heart failure

medicine dopingChronic heart failure (CHF) is a progressive disease which manifests itself as a decrease in cardiac output accompanied with myocardial dysfunction. The most common cause of CHF is the ischemic heart disease (IHD) but it may also be a complication of hypertension, cardiomyopathy or myocarditis. Disease is characterized with high mortality, 50% of patients die within 5 years of diagnosis. Therefore the search for new therapeutic approaches, that could improve these statistics continues.

The last few years have brought many surprising reports on pleiotropic effect of vitamin D3 on the human body. Moreover low level of Vitamin D in patients suffering from cardiovascular diseases has been proven. A team of scientists from Leeds Institute of Cardiovascular and Metabolic Medicine for one year have evaluated the effects of vitamin D3 supplementation on submaximal exercise capacity and function of the heart muscle. The results were presented in the Journal of the American College of Cardiology.

A randomized double-blind placebo controlled study was conducted on 229 participants. Patients were selected on the basis of the presence of heart failure NYHA class II or III symptoms, a left ventricular ejection fraction (LVEF) ≤45% and a 25(OH) vitamin D level of <50nmol/L. The participants were divided into two groups. In the first group, patients took 4000 IU of vitamin D3 daily, while in the second non-calcium-based placebo. The dose was determined on the basis of the guidelines for supplementation of vitamin D3. The evaluation of the treatment effect was based on of three variables: 6-minute walk test (6MWT), changes in left ventricular ejection fraction (LVEF) and left ventricle measurements. The possible side effects of the high doses of vitamin D were controlled every three months for a year by verifying the serum calcium, vitamin D, parathyroid hormone and serum creatinine levels. Research has shown that one year of high-dose vitamin D supplementation has not improved 6-minute walk distance after one year of use, but was associated with a clinically significant improvement in cardiac function (increase in LVEF +6,07%). Moreover reduce of left ventricular end diastolic diameter (LVEDd) -2.49mm and left ventricular end systolic diameter (LVESd) -2,09mm was reported. These facts indicate a reversal of left ventricular remodeling process. During the study there were no significant changes of calcium level or renal function.

In summary, the research indicates that the supplementation with high doses of vitamin D3 (4000IU daily) in patients with CHF is safe, well tolerated and not related to concerning adverse biochemical effects. In addition, such therapy is associated with beneficial effects on the hemodynamic function of the heart and may be an additional therapeutic option for patients with CHF. It remains unclear whether the deficiency of vitamin D3is a marker of disease severity or plays an important role in the extremely complex pathophysiology of the disease.

Written by: Hubert Opaliński, Katarzyna Godzisz, Michał Godzisz

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