Effect of vitamin D on all-cause mortality in heart failure (EVITA): a 3-year randomized clinical trial with 4000 IU vitamin D daily.
Eur Heart J. 2017 May 12. doi: 10.1093/eurheartj/ehx235. [Epub ahead of print]
Zittermann A1 , Ernst JB1, Prokop S1, Fuchs U1, Dreier J2, Kuhn J2, Knabbe C2, Birschmann
I2, Schulz U1, Berthold HK3, Pilz S4, Gouni-Berthold I5, Gummert JF1, Dittrich M6, Börgermann J1.
Many strange things
- The RCT listing only mentions Ergocalciferols, but not D3, yet the publication says it used D3
- More that half of the people decided to not participate in the RCT. A study has found serious problems with RCT results when so many did not participate
- This RCT selected only those people with chronic heart failure (80% had pacemakers), not the general public. Perhaps people with chronic heart failure are more likely to have poor a Vitamin D Receptor than the healthy public, and thus would need significantly higher levels of Vitamin D (> 50 ng?) to get enough Vitamin D to their heart cells.
- The average vitamin D level achieved was 40 ng – where Vitamin D starts to help the healthy
RCT failed to compare results for those < 40 ng and > 40 ng
- About 45% of the participants did not continue to take the vitamin D for the entire RCT - were those people healthier?
- 50,000 IU of vitamin D weekly following cardiac failure helps – RCT 2014
- 50,000 IU of Vitamin D for 9 weeks was enough to restore blood levels (but not long enough to statistically improve CVD) – Aug 2018
- Cardiovascular risk markers not helped by 20,000 IU of vitamin D weekly – RCT May 2018
- Heart attack ICU costs cut in half by Vitamin D – Oct 2018
- Hypertension not controlled by 26 ng of Vitamin D (50,000 IU bi-weekly A-A) – RCT Nov 2017
- Heart Failure not helped by Vitamin D (several strange things about the trial) – RCT May 2017
- Chronic Heart Failure improved with 4,000 IU daily for a year – RCT April 2016
- Cardiovascular death reduction in dark skin migrants by just 1,000 IU of vitamin D – May 2015
- Heart failure markers reduced by 400 IU of vitamin D and Calcium (surprise) – RCT Jan 2015
- Angina dramatically reduced by injections of vitamin D twice a month (300,000 IU) – Jan 2015
- Salmon intervention (vitamin D and Omega-3) improved heart rate variability and reduced anxiety – Nov 2014
- 1700 IU vitamin D for a year provided no cardiovascular benefit (no surprise) – RCT Oct 2014
- Seniors with Heart Failure helped by daily 4,000 IU of vitamin D (increase 16 ng) – RCT Aug 2014
- Hearts responded to stress better after 5,000 IU of vitamin D for a month - March 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
- 4000 IU vitamin D daily for just 5 days reduced inflammation after heart attack – RCT Jan 2013
- Congestive heart failure in infants virtually cured by 1000 IU of vitamin D – RCT Feb 2012
- Chance of death after heart failure reduced by 1000 IU of vitamin D – Feb 2012
Cardiovascular category in VitaminDWiki 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
- Heart Failure and Vitamin D meta-analyses - 2016, 2019
- Cardiovascular death 1.5X more likely if less than 20 ng of Vitamin D – 22nd meta-analysis Nov 2019
- Vitamin D supplementation reduces many Cardiovascular Disease markers– meta-analysis July 2018
- Cardiovascular Prevention with Omega-3 (finally using high doses) – Sept 2019
- Higher Omega-3 index (4 to 8 percent) associated with 30 percent less risk of coronary disease (10 studies) July 2017
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 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
- Cardiovascular deaths 12 percent less likely if have 10 ng more vitamin D – meta-analysis March 2017
- C-reactive protein (heart disease marker) reduced by vitamin D – meta-analysis 2014, 2019
See also Vitamin D Council on this study
Circulating 25-hydroxyvitamin D (25OHD) levels <75 nmol/L are associated with a nonlinear increase in mortality risk. Such 25OHD levels are common in heart failure (HF). We therefore examined whether oral vitamin D supplementation reduces mortality in patients with advanced HF.
METHODS AND RESULTS:
Four hundred HF patients with 25OHD levels <75 nmol/L were randomized to receive 4000 IU vitamin D daily or matching placebo for 3 years. Primary endpoint was all-cause mortality.
Key secondary outcome measures included, hospitalization, resuscitation, mechanical circulatory support (MCS) implant, high urgent listing for heart transplantation, heart transplantation, and hypercalcaemia.
Initial 25OHD levels were on average <40 nmol/L, remained around 40 nmol/L in patients assigned to placebo and plateaued around 100 nmol/L in patients assigned to vitamin D.
Mortality was not different in patients receiving vitamin D (19.6%; n = 39) or placebo (17.9%; n = 36) with a hazard ratio (HR) of 1.09 [95% confidence interval (CI): 0.69-1.71; P = 0.726].
The need for MCS implant was however greater in patients assigned to vitamin D (15.4%, n = 28) vs. placebo [9.0%, n = 15; HR: 1.96 (95% CI: 1.04-3.66); P = 0.031].
Other secondary clinical endpoints were similar between groups. The incidence of hypercalcaemia was 6.2% (n = 10) and 3.1% (n = 5) in patients receiving vitamin D or placebo (P = 0.192).
A daily vitamin D dose of 4000 IU did not reduce mortality in patients with advanced HF but was associated with a greater need for MCS implants. Data indicate caution regarding long-term supplementation with moderately high vitamin D doses.
Trial listing: NCT01326650
PMID: 28498942 DOI: 10.1093/eurheartj/ehx235 Publisher wants $42 for the PDF
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