Association of Vitamin D Deficiency with Heart Failure and Sudden Cardiac Death in a Large Cross-Sectional Study of Patients Referred for Coronary Angiography

• Published in: The journal of clinical endocrinology and metabolism Vol. 93; no. 10; pp. 3927 - 3935
• Main Authors: Pilz, Stefan, März, Winfried, Wellnitz, Britta, Seelhorst, Ursula, Fahrleitner-Pammer, Astrid, Dimai, Hans P., Boehm, Bernhard O., Dobnig, Harald
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Oxford University Press 01.10.2008; Endocrine Society
• Subjects: 25-Hydroxyvitamin D; Aged; Angiography; Biological and medical sciences; Brain natriuretic peptide; Calcium homeostasis; Cardiovascular diseases; Clinical trials; Cohort Studies; Congestive heart failure; Coronary Angiography; Coronary artery disease; Cross-Sectional Studies; Death; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - pathology; Dietary supplements; Endocrinopathies; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Heart failure; Heart Failure - blood; Heart Failure - epidemiology; Heart Failure - etiology; Homeostasis; Humans; Male; Medical imaging; Medical sciences; Middle Aged; Muscle contraction; Nutrient deficiency; Prevalence; Referral and Consultation; Risk Factors; Statistical analysis; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Vitamin D; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin D Deficiency - epidemiology; Vitamin deficiency; Human; Heart failure; Obesity; Radiodiagnosis; Nutrition; Sudden death; Nutrition disorder; Cardiovascular disease; Vitamin deficiency; Patient; Metabolic diseases; Coronary arteriography; Metabolic disorder; Association; Vitamin D; Heart disease; Cross sectional study; Malnutrition; Nutritional status; Endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2008-0784

Context: Vitamin D has been shown to influence cardiac contractility and myocardial calcium homeostasis. Objectives: We aimed to elucidate whether insufficient vitamin D status is associated with heart failure and sudden cardiac death (SCD). Design, Setting, and Participants: We measured 25-hydroxyvitamin D [25(OH)D] levels in 3299 Caucasian patients who were routinely referred to coronary angiography at baseline (1997–2000). Main Outcome Measures: The main outcome was cross-sectional associations of 25(OH)D levels with measures of heart failure and Cox proportional hazard ratios for deaths due to heart failure and for SCD according to vitamin D status. Results: 25(OH)D was negatively correlated with N-terminal pro-B-type natriuretic peptide and was inversely associated with higher New York Heart Association classes and impaired left ventricular function. During a median follow-up time of 7.7 yr, 116 patients died due to heart failure and 188 due to SCD. After adjustment for cardiovascular risk factors, the hazard ratios (with 95% confidence intervals) for death due to heart failure and for SCD were 2.84 (1.20–6.74) and 5.05 (2.13–11.97), respectively, when comparing patients with severe vitamin D deficiency [25(OH)D <25 nmol/liter)] with persons in the optimal range [25(OH)D ≥75 nmol/liter]. In all statistical analyses, we obtained similar results with 25(OH)D and with 1,25-dihydroxyvitamin D. Conclusions: Low levels of 25(OH)D and 1,25-dihydroxyvitamin D are associated with prevalent myocardial dysfunction, deaths due to heart failure, and SCD. Interventional trials are warranted to elucidate whether vitamin D supplementation is useful for treatment and/or prevention of myocardial diseases.