Serum Vitamin D Levels Predict 30-day Readmission Rate and Length of Stay in Hospitalized Patients with an Acute Heart Failure Syndrome due to Reduced Ejection Fraction
Journal of Cardiac Failure Vol. 23 No. 8S August 2017
Fadi Ghrair1, Hassan Alkhawam2, Anwar Zaitoun3, Feras Zaiem4, Amir Sara5, David Rubinstein6, Timothy J. Vittorio7; 1Icahn School of Medicine at Mount Sinai (Elmhurst), Astoria, NY; 2Saint Louis University School of Medicine, St. Louis, MO; 3Saint John Hospital and Medical Center, Detroit, MI; 4Mayo Clinic, Rochester, MN; 5Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 6Icahn School of Medicine at Mount Sinai (Elmhurst), New York, NY; 7St. Francis Hospital—the Heart Center®, Roslyn, NY
- Risk of Cardiac failure reduced 20 percent by 800 IU of vitamin D and Calcium – meta-analysis July 2014
- Chronic Heart Failure improved with 4,000 IU daily for a year – RCT April 2016
- Heart Attack ICU costs reduced $37,000 by $20 of Vitamin D – Nov 2015
- Overview Cardiovascular and vitamin D
Cardiovascular category starts with the following
- Overview Cardiovascular and vitamin D
- Hypertension and vitamin D
- Overview Metabolic Syndrome and vitamin D
- Overview Stroke and vitamin D
- Peripheral arterial disease risk is 1.5X higher if low vitamin D – meta-analysis March 2018
- Peripheral Arterial Disease 3.7 X more likely in diabetics with low vitamin D – June 2019
- Heart attack ICU costs cut in half by Vitamin D – Oct 2018
Meta-analyses (auto-updated)
- Arterial stiffness reduced if use at least 2,000 IU of Vitamin D for 4 months – meta-analysis Dec 2019
- Blood vessels not helped by small vitamin D doses – meta-analysis Dec 2019
- Vitamin D supplementation reduces many Cardiovascular Disease markers– meta-analysis July 2018
- Low-dose vitamin D does not help cardiovascular (many were 100-1,000 IU) – meta-analysis June 2019
- Heart Failure and Vitamin D meta-analyses - 2016, 2019
- Vitamin K (across all dose sizes and types) decrease Vascular Stiffness – meta-analysis - Dec 2018
- Small or infrequent doses of vitamin D do not reduce heart failure much – meta-analysis Jan 2018
- Peripheral arterial disease risk is 1.5X higher if low vitamin D – meta-analysis March 2018
- Omega-3 reduced time in hospital and atrial fibrillation after cardiac surgery – meta-analysis May 2016
- Cardiovascular deaths 12 percent less likely if have 10 ng more vitamin D – meta-analysis March 2017
- Health problems prevented by eating nuts (perhaps due to Magnesium and or Omega-3) – meta-analysis Dec 2016
- Atrial Fibrillation 1.3 times more likely if low vitamin D – meta-analysis Sept 2016
- Coronary Artery Disease without diabetes 5 times more likely if VDR gene problems – meta-analysis May 2016
- Chronic Heart Failure not treated by Vitamin D, if dose size is ignored – meta-analysis Oct 2015
- Atrial fibrillation sometimes treated by Omega-3 – meta-analysis Sept 2015
- Peripheral Arterial Disease patients have low vitamin D levels – meta-analysis Oct 2015
- C-reactive protein (heart disease marker) reduced by vitamin D – meta-analysis 2014, 2019
- Cardiovascular disease associated with postmenopausal non-human primates – meta-analysis Jan 2015
- Adding Calcium does NOT cause cardiovascular problems (reverses their meta-analysis) – Dec 2014
- Statin pain associated with 10 ng less vitamin D – meta-analysis Oct 2014
- Risk of Cardiac failure reduced 20 percent by 800 IU of vitamin D and Calcium – meta-analysis July 2014
- Magnesium prevents cardiovascular events – Meta-analysis March 2013
- Cardiovascular disease 50 % more likely if low vitamin D - meta-analysis Nov 2012
- Omega-3 does not help heart patients – meta-analysis Sept 2012
- Half as many heart deaths for those with high levels of vitamin D – meta-analysis Sept 2012
- Shift workers 23 percent more likely to have cardiovascular events – meta-analysis July 2012
- Low density lipoprotein cholesterol is predictable from vitamin D levels – meta-analysis March 2012
- 800 IU Vitamin D does not help heart – meta-analysis Aug 2011
- Calcium without vitamin D increased heart risk by 30 percent - Jan 2011
- Meta-analysis unsure if vitamin D can prevent cardiovascular disease – Sept 2010
Omega-3 Helps (auto-updated)
- Omega-3 reduced cardiovascular deaths by 16 percent (427,678 people) – March 2020
- Synthetic EPA drug recommended to FDA for Cardio (Omega-3 is 8 X better) – Nov 2019
- Omega-3 reduces heart problems by ~5 percent – meta-analysis by Heart Association Oct 2019
- Cardiovascular Prevention with Omega-3 (finally using high doses) – Sept 2019
- Few people have enough EPA (an Omega-3) to reduce heart failures – July 2019
- Another Nail in the Coffin for Fish Oil Supplements (nope) – JAMA April 2018
- Omega-3 provides many cardiovascular benefits – April 2018
- Omega-3 helps the heart, AHA class II recommendation, more than 1 gm may be needed – March 2018
- 3 days of Omega-3 before cardiac surgery reduced risk of post-op bleeding by half – RCT March 2018
- Perhaps the Omega-3 optimal level is 10 percent, not 8 – Feb 2018
- Omega-3 Cardiovascular meta-analysis has at least 5 major problems – Jan 2018
- Benefits of Omega-3 beyond heart health - LEF Feb 2018
- Higher Omega-3 index (4 to 8 percent) associated with 30 percent less risk of coronary disease (10 studies) July 2017
- Cardiovascular problems reduced by low dose aspirin and perhaps Omega-3 (also Vit K) – Sept 2017
- Omega-3 reduced time in hospital and atrial fibrillation after cardiac surgery – meta-analysis May 2016
- For every Omega-3 dollar there is a 84 dollar savings in Cardiovascular costs - Foster and Sullivan April 2016
- High dose Omega-3 probably reduces heart problems – American Heart Association – March 2017
- Health problems prevented by eating nuts (perhaps due to Magnesium and or Omega-3) – meta-analysis Dec 2016
- Omega-3 – need more than 1 gram for a short time to reduce Cardiovascular Disease – Nov 2016
- Omega-3 is vital for health, mail-in test is low cost and accurate
- Cardiovascular calcification prevented by Omega-3, Magnesium, Vitamin K, and Vitamin D – April 2015
- Atrial fibrillation sometimes treated by Omega-3 – meta-analysis Sept 2015
- Salmon intervention (vitamin D and Omega-3) improved heart rate variability and reduced anxiety – Nov 2014
- Omega-7 - in addition to Omega-3
- Omega-3 reduces Coronary Heart Disease - infographic June 2014
- Cardiovascular diseases – conflicting data on benefits of Omega-3 and vitamin D – Feb 2014
- Cardiovascular system benefits from both Omega-3 and vitamin D – Dec 2012
- Heart problems such as Afib related to little Magnesium, Omega-3, Vitamin D getting to tissues
- Omega-3 does not help heart patients – meta-analysis Sept 2012
A poor Vitamin D Receptor can block Vitamin D in blood from getting to tissues
- Heart Failure 15X more likely if poor VDR, even if good level of vitamin D (China) – March 2019
- Coronary Artery Disease without diabetes 5 times more likely if VDR gene problems – meta-analysis May 2016
Cholesterol, Statins
- Cholesterol is needed to produce both Vitamin D and Cortisol
- Overview Cholesterol and vitamin D
- Statins and vitamin D statins often reduce levels of vitamin D
- Statin side-effects are reduced by Vitamin D – US patent Application – April 2019
Introduction: More than 90% of patients with heart failure with reduced ejection fraction (HErEF) are vitamin D deficient. Lower vitamin D levels have been linked to higher NYHA classes and increased mortality among HFrEF patients. However, data on the relationship between serum vitamin D level and hospitalization are scarce. Our study aims to assess the association of serum vitamin D level with 30-day readmission rate and length of stay (LOS) in patients with acute heart failure (AHF) syndrome due to HFrEF.
Methods: Aretrospective, single-center study of 2,087 patients admitted between January 1, 2005 and December 31, 2014 for an AHF syndrome was performed. Patients without a vitamin D level or measured as 25-dihydroxyvitamin D (25OHD were excluded from our study. 25(OH)D deficiency was defined by having serum concentration levels of less than 20 ng/mL. Normal levels were defined as >30 ng/mL. We assessed levels of 25(OH)D in relation to predicting the 30-day readmission rate, length of stay (LOS) and mortality rate.
Results: Among the 2,087 patients admitted to our hospital for an AHF syndrome, 180 patients had a history of HFrEF and documented levels of vitamin D, of which 42 patients (23.3%) had normal 25(OH)D levels, 83 patients (46.1%) had 25(OH)D deficiency and 55 patients (30.6%) had 25(OH)D insufficiency. The average age of the patients admitted for an AHF syndrome was 62.7 years in HFrEF-25(OH)D deficiency group versus 69.9 years in HFrEF-normal 25(OH)D level (P = .007).
After standardizing medical therapy in each group, the 30-day readmission rate among HFrEF-25(OH)D deficiency was 40% versus 16.6% in HFrEF- normal 25(OH)D level (Odds ratio (OR) 3.4, 95% CI: 1.3-9.3, P = .01). Average LOS among HFrEF-25(OH)D deficiency group was 8.2 days versus 4.1 days in HFrEF- normal 25(OH)D level (P = .04).
Mortality rate did not differ between the two groups. Subgroup analysis among HFrEF-25(OH)D deficiency, average age during the AHF syndrome admission was 60.1 years among male patients versus 67 years in female patients (P = .04). Furthermore, female patients had a higher 30-day readmission rate compared to male patients (26.7% vs 11.8%) with a trend toward statistical significance (P = .07). LOS did not differ between the male and female subgroups (P = .8).
Conclusions: Vitamin D deficiency seems to be a significant independent predictor for an early age of hospitalization, 30-day readmission rate and LOS among HFrEF patients admitted for anAHF syndrome. Further studies are warranted to evaluate vitamin D supplementation on patient outcomes.
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