Vitamin D Deficiency can Accelerate Heart Failure: A Systematic Review and Meta-analysis
Irem Akin1 and Nuray Yazihan1,2*
1Metabolism and Clinical Nutrition Department, Ankara University, Institute of Health Sciences Interdisciplinary Food, Ankara, Turkey
2Department of Pathophysiology, Ankara University, Faculty of Medicine, Ankara, Turkey
*Corresponding Author: Nuray Yazihan, Professor, Internal Medicine, Department of Pathophysiology, Ankara University, Faculty of Medicine, Ankara, Turkey.
April 07, 2021; Published: June 24, 2021
Background: Cardiovascular diseases (CVDs) are one of the most important causes of mortality all around the world. Studies have been shown that vitamin D is closely related CVDs, including heart failure (HF). We aim to assess the serum vitamin D levels in patients with HF in this meta-analysis.
Methods: A systematic research was performed in Pubmed, Web of Science, and Scopus databases for following keywords; "vitamin D level" OR "vitamin D status" AND "heart failure" until September 2020. Each step of the meta-analysis is appropriate to the PRISMA guideline. Totally, 2968 publications were screened and 16 articles were found to have suitable data. Analysis was done with RevMan 5.3. software. We also used GraphPad Prism 6 software for the correlation analysis and figures.
Results: Our pooled data showed that patients with HF had significantly lower levels of serum vitamin D compared to controls (REM p < 0.00001 mean difference: -8.20 [-10.46, -5.95]). There was also significant correlation between serum vitamin D level and left ventricular ejection fraction (LVEF) (p: 0.0134, r: 0.4785) (n = 26).
Conclusion: In this meta-analysis, it has been indicated that HF patients have lower serum vitamin D levels compared to controls. As seen in our study, vitamin D might be an important risk factor for HF, and vitamin D deficiency (VDD) may lead increased mortality caused by HF. Further researches are needed to elucidate which mechanisms play a role in the association between HF and vitamin D.
Keywords: Vitamin D; Vitamin D Deficiency; Cardiovascular Diseases; Heart Failure; Meta-analysis
- D'Amore C., et al. “Vitamin D deficiency and clinical outcome in patients with chronic heart failure: A review”. Nutrition, Metabolism and Cardiovascular Diseases 10 (2017): 837-849.
- Brinkley DM., et al. “Vitamin D and Heart Failure”. Current Heart Failure Reports 5 (2017): 410-420.
- Meems LM vdHP., et al. “Vitamin D biology in heart failure: molecular mechanisms and systematic review”. Current Drug Targets1 (2011): 29-41.
- Wang TJ PM., et al. “Vitamin D deficiency and risk of cardiovascular disease”. Circulation 4 (2008): 503-511.
- Kestenbaum B., et al. “Vitamin D, parathyroid hormone, and cardiovascular events among older adults”. Journal of the American College of Cardiology14 (2011): 1433-1441.
- Yancy CW., et al. “2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines”. Journal of the American College of Cardiology16 (2013): e240-327.
- Anderson JL., et al. “Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population”. American Journal of Cardiology7 (2010): 963-968.
- Kim DH., et al. “Prevalence of Hypovitaminosis D in Cardiovascular Diseases (from the National Health and Nutrition Examination Survey 2001 to 2004)”. American Journal of Cardiology11 (2008): 1540-1544.
- Gotsman I SA., et al. “Vitamin D deficiency is a predictor of reduced survival in patients with heart failure vitamin D supplementation improves outcome”. European Journal of Heart Failure 4 (2012): 357-366.
- Aparicio-Ugarriza R., et al. “Is vitamin D deficiency related to a higher risk of hospitalization and mortality in veterans with heart failure?” Maturitas 132 (2020): 30-34.
- Cubbon RM., et al. “Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure”. European Journal of Nutrition6 (2019): 2535-2543.
- Higgins JPT., et al. “Measuring inconsistency in meta-analyses”. BMJ 7414 (2003): 557-560.
- Borenstein M., et al. “Fixed-effect versus random-effects models”. Introduction to Meta-analysis 77 (2009): 85.
- Higgins JP. “Cochrane handbook for systematic reviews of interventions version 5.1.0”. The Cochrane Collaboration (2011).
- Arslan AK and Tolunay H. “Analysis of Bone Mineral Density and Hip Fracture in Geriatric Patients with Heart Failure”. Konuralp Medical Journal2 (2019): 242-246.
- Atamañuk AN., et al. “Vitamin D deficiency among patients with pulmonary hypertension”. BMC Pulmonary Medicine1 (2019): 258.
- Bozic B., et al. “Relationship Between High Circulating Adiponectin With Bone Mineral Density and Bone Metabolism in Elderly Males With Chronic Heart Failure”. Journal of Cardiac Failure4 (2010): 301-307.
- Buleu FN., et al. “Correlations between Vascular Stiffness Indicators, OPG, and 25-OH Vitamin D3 Status in Heart Failure Patients”. Medicina (Kaunas)6 (2019): 309.
- Cetin M., et al. “Could decreased vitamin D levels be related with impaired cardiac autonomic functions in patients with chronic heart failure: an observational study”. Anadolu Kardiyol Dergs5 (2014): 434-441.
- DiCarlo C., et al. “Body mass index and 25 hydroxyvitamin D status in patients with and without heart failure”. Congest Heart Fail3 (2012): 133-137.
- Hamdy NM., et al. “Involvement of Depressive Catecholamines as Thrombosis Risk/Inflammatory Markers in Non-Smoker, Non-Obese Congestive Heart Failure, Linked to Increased Epidermal Growth Factor-Receptor (EGF-R) Production”. Indian Journal of Clinical Biochemistry 2 (2011): 140-145.
- Kenny AM., et al. “Femoral bone mineral density in patients with heart failure”. Osteoporosis International 9 (2006): 1420-1427.
- Kolaszko A., et al. “The Role of Parathyroid Hormone and Vitamin D Serum Concentrations in Patients with Cardiovascular Diseases”. Disease Markers 2018 (2018): 5287573.
- Lewandowski T BA., et al. “The evaluation of 25 (OH)D concentration in blood serum of chronic heart failure patients”. Current Issues in Pharmacy and Medical Sciences 3 (2016): 107-110.
- Loncar G., et al. “Association of increased parathyroid hormone with neuroendocrine activation and endothelial dysfunction in elderly men with heart failure”. Journal of Endocrinological Investigation3 (2011): e78-e85.
- Loncar G., et al. “Association of adiponectin with peripheral muscle status in elderly patients with heart failure”. European Journal of Internal Medicine8 (2013): 818-823.
- Nedeljkovic BB., et al. “Relationship of High Circulating Cystatin C to Biochemical Markers of Bone Turnover and Bone Mineral Density in Elderly Males with a Chronic Heart Failure”. Journal of Medical Biochemistry 1 (2019): 53-62.
- Saponaro F., et al. “Vitamin D measurement and effect on outcome in a cohort of patients with heart failure”. Endocrine Connect9 (2018): 957-964.
- Terrovitis J., et al. “Bone mass loss in chronic heart failure is associated with secondary hyperparathyroidism and has prognostic significance”. European Journal of Heart Failure 3 (2012): 326-332.
- Wu C., et al. “Dynamics of bone turnover markers in patients with heart failure and following haemodynamic improvement through ventricular assist device implantation”. European Journal of Heart Failure12 (2012): 1356-1365.
- Nitsa A., et al. “Vitamin D in Cardiovascular Disease”. In Vivo5 (2012): 977-981.
- Beveridge LA and Witham MD. “Vitamin D and the cardiovascular system”. Osteoporosis International8 (2013): 2167-2180.
- Martinesi M., et al. “1,25-Dihydroxyvitamin D3 inhibits tumor necrosis factor-α-induced adhesion molecule expression in endothelial cells”. Cell Biology International4 (2006): 365-375.
- Cardús A., et al. “1,25-Dihydroxyvitamin D3 stimulates vascular smooth muscle cell proliferation through a VEGF-mediated pathway”. Kidney International8 (2006): 1377-1384.
- Molinari C., et al. “1α,25-Dihydroxycholecalciferol Induces Nitric Oxide Production in Cultured Endothelial Cells”. Cellular Physiology and Biochemistry6 (2011): 661-668.
- Camici M., et al. “Vitamin D and heart”. Internal and Emergency Medicine1 (2013): 5-9.
- Mancuso P., et al. “1,25-Dihydroxyvitamin-D3 treatment reduces cardiac hypertrophy and left ventricular diameter in spontaneously hypertensive heart failure-prone (cp/+) rats independent of changes in serum leptin”. Journal of Cardiovascular Pharmacology6 (2008): 559-564.
- Simpson RU., et al. “Characterization of heart size and blood pressure in the vitamin D receptor knockout mouse”. The Journal of Steroid Biochemistry and Molecular Biology3-5 (2007): 521-524.
- Rahman A., et al. “Heart extracellular matrix gene expression profile in the vitamin D receptor knockout mice”. The Journal of Steroid Biochemistry and Molecular Biology3 (2007): 416-419.
- Li YC., et al. “1,25-Dihydroxyvitamin D (3) is a negative endocrine regulator of the renin-angiotensin system”. Journal of Clinical Investigation2 (2002): 229-238.
- Forman JP., et al. “Plasma 25-hydroxyvitamin D and regulation of the renin-angiotensin system in humans”. Hypertension5 (2010): 1283-1288.
- Tomaschitz A., et al. “Independent association between 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D and the renin–angiotensin system: The Ludwigshafen Risk and Cardiovascular Health (LURIC) study”. Clinica Chimica Acta17 (2010): 1354-1360.
- Costanzo S., et al. “Serum vitamin D deficiency and risk of hospitalization for heart failure: Prospective results from the Moli-sani study”. Nutrition, Metabolism and Cardiovascular Diseases3 (2018): 298-307.
- Hou Y-M., et al. “Impact of serum 25-hydroxyvitamin D on cardiac prognosis in Chinese patients with heart failure”. British Journal of Nutrition2 (2019): 162-171.
- Pilz S., et al. “Association of Vitamin D Deficiency with Heart Failure and Sudden Cardiac Death in a Large Cross-Sectional Study of Patients Referred for Coronary Angiography”. The Journal of Clinical Endocrinology and Metabolism10 (2008): 3927-3935.
- Witham MD CL., et al. “The effects of vitamin D supplementation on physical function and quality of life in older patients with heart failure: a randomized controlled trial”. Circulation: Heart Failure2 (2010): 195-201.
- Moretti HD., et al. “Vitamin D (3) repletion versus placebo as adjunctive treatment of heart failure patient quality of life and hormonal indices: a randomized, double-blind, placebo-controlled trial”. BMC Cardiovascular Disorder1 (2017): 274.