By: JENNIE SMITH, Cardiology News Digital Network APR 4, 2016
Ejection fraction (% of blood ejected for each pump of the heart)
- 60%-70% good heart
- 26% before start of trial and after 1 year of placebo
- 34% after 1 year of 4,000 IU of vitamin D
- However, no improvement in distance traveled for 6 minute walk
See also VitaminDWiki
- Risk of Cardiac failure reduced 20 percent by even a small amount of vitamin D – meta-analysis July 2014
- Seniors with Heart Failure helped by daily 4,000 IU of vitamin D (increase 16 ng) – RCT Aug 2014
- More blood was pumped by those getting 800,000 IU of vitamin D after heart failure – RCT Oct 2013
- Chronic Heart Failure helped with 2,000 IU of vitamin D (PRA reduced) – RCT June 2013
- Heart failure 2X more likely if less than 20 ng of vitamin D – Sept 2012
perhaps vitamin D can PREVENT CHF
- Death in less than 2 years of Heart Failure associated with low vitamin D - April 2012
- Patent for patients of Chronic Heart Failure includes vitamin D – June 2011
A patent is often a good indication that something actually works
- 96 percent of heart failure patients had less than 30 ng of vitamin D – March 2011
- Chronic Heart Failure not treated by Vitamin D, if dose size is ignored – meta-analysis Oct 2015
- Overview Cardiovascular and vitamin D
- Hypertension and vitamin D
- Overview Metabolic Syndrome and vitamin D
- Overview Stroke and vitamin D
- Heart Attack 647 items as of May 2018
- Arrhythmia OR “atrial fibrillation” 497 items as of May 2018
- (Arrhythmia OR “atrial fibrillation”) AND Magnesium 345 items as of May 2018
- "C-Reactive Protein" 992 items as of May 2018
- TRIGLYCERIDES 863 items as of May 2018
- "Peripheral Artery Disease" 81 items as of Oct 2017
- "Sudden Cardiac Arrest" 98 items as of May 2018
- Search VitaminDWiki for CHF or "HEART FAILURE" 1220 items as of Aug 2017
- Search VitaminDWiki for Atherosclerosis 726 items as of Oct 2017
- 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
68 proofs that Vitamin D works (as of March 2016)
Proof that Vitamin D Works has the following concerning the heart
|Health Problem|| Treat|
click for details
|RCT = Random Controlled Trial |
* = link to additional RCT
CT = Clinical Trial
|Hypertension||T||149 to 142 mm Hg||RCT* *, 2400 IU. 100,000 IU*||1|
|Cardiovascular after attack||T||32 % fewer deaths||CT 1000 IU||2|
|Diabetes T2||T||62 %||RCT* *, CRP reduction, 4000 IU||4|
|Congestive Heart Failure||T||90 %||RCT, 1000 IU infants (also: Adults, not RCT)||27|
|After Heart Attack||T __||+6% ejection fraction||RCT, 800,000 IU one time||34|
Key clinical point: Oral supplementation of high-dose vitamin D3 led to significantly improved left ventricular function and structure in a cohort of vitamin-deficient patients.
Major finding: Treated patients had significantly improved left ventricular ejection fraction of +6.07% vs. nontreated patients at 1 year, and significant reversal of left ventricular remodeling (left ventricular end diastolic diameter –2.49 mm and left ventricular end systolic diameter –2.09 mm).
Data source: A single-site randomized trial in which 229 patients with LV CHF received high-dose vitamin D or placebo for 12 months.
Disclosures: The U.K.’s National Institute for Health Research supported the study, and none of its authors declared conflicts of interest.
High-dose oral vitamin D supplements taken for 1 year significantly improved cardiac structure and function in patients with chronic heart failure secondary to left ventricular systolic dysfunction, according to results from a new study.
However, the same study. led by Dr. Klaus Witte of the University of Leeds (England), found that 6-minute walk distance – the study’s primary outcome measure – was not improved after a year’s supplementation with vitamin D.
It is unclear why vitamin D deficiency co-occurs in a majority of people with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD) or to what degree reversing it can improve outcomes. However, vitamin D deficiency is thought to interfere with calcium transport in cardiac cells, and may contribute to cardiac fibrosis and inflammation, leading to faster progression to heart failure following damage to cardiac muscle.
The new VINDICATE study randomized 223 patients with CHF due to LVSD and vitamin D deficiency to 1 year’s treatment with 4,000 IU of 25(OH) vitamin D3 daily, or placebo, Dr. Witte and associates concluded at the annual meeting of the American College of Cardiology. The results were published online April 4 in JACC (doi: 10.1016/j.jacc.2016.03.508).
Of these patients, 163 completed follow-up at 12 months, and 6-minute walk distance (MWT) and echocardiography findings were recorded at baseline and follow-up.
Dr. Witte and colleagues found significant evidence of improved function in the vitamin D–treated patients as measured by left ventricular ejection fraction +6.07% (95% confidence interval 3.20, 8.95; P less than .0001); and a reversal of left ventricular remodeling (left ventricular end diastolic diameter –2.49 mm (95% CI –4.09, –0.90; P equal to .002) and left ventricular end systolic diameter –2.09 mm (95% CI –4.11; –0.06; P equal to .043).
The researchers also drew blood at 3-month intervals to check for serum calcium concentration, renal function, and vitamin D levels. Treatment was well tolerated, and no patients suffered hypervitaminosis or required a dose adjustment.
“There was no effect of vitamin D supplementation on the primary endpoint of 6 MWT distance but there were statistically significant, and prognostically and clinically relevant improvements in the secondary outcomes of left ventricular ejection fraction, dimensions, and volumes, suggesting that vitamin D is leading to beneficial reverse remodeling,” the investigators wrote in their analysis.
The study’s failure to meet its primary endpoint despite significant results from its secondary endpoints led Dr. Witte and colleagues to say that its design led to underpowering.
“Variability in the walk distance measure at baseline was much greater than predicted from our pilot study such that our sample size only had 7% post hoc power to detect a difference between the groups,” meaning it was underpowered to detect a clinically relevant change in walk distance. The findings “have implications for future studies using 6-minute walk distance as an outcome measure,” they wrote.
The investigators championed the addition of vitamin D3 to CHF treatment regimens.
As new therapies for CHF are “often expensive, increasingly technical, and frequently fail to meet the rigorous demands of large phase III clinical trials,” Dr. Witte and colleagues wrote, vitamin D “might be a cheap and safe additional option for CHF patients and may have beneficial effects on multiple features of the syndrome.”
The U.K.’s National Institute for Health Research supported the study, and none of its authors declared conflicts of interest.
- The ejection fraction of a healthy person is usually between 60% and 70%. In heart failure patients, the ejection fraction is often significantly impaired — in the patients enrolled into the VINDICATE study the average ejection fraction was 26%.
- In the 80 patients who took Vitamin D3, the heart's pumping function improved from 26% to 34%. In the others, who took placebo, there was no change in cardiac function.
- This means that for some heart disease patients, taking vitamin D3 regularly may lessen the need for them to be fitted with an implantable cardioverter defibrillator (ICD), a device which detects dangerous irregular heart rhythms and can shock the heart to restore a normal rhythm.
- Heart failure affects about 900,000 people in the UK and more than 23 million worldwide.
- The condition can affect people of all ages, but it is more common in older people — more than half of all people globally with heart failure are over the age of 75.