(2010) Liu, Licette C.Y.
http://scripties.umcg.eldoc.ub.rug.nl/root/geneeskunde/2010/LiuLicetteC.Y./
Introduction
In a large heart failure (HF) cohort we investigated whether a low vitamin D concentration
is associated with a poor prognosis in HF, and whether activation of the renin-angiotenin-system (RAS) and cytokines are related to this association.
Methods
We studied 548 patients hospitalized due to HF. We evaluated the correlation between 25-
hydroxy vitamin D (nmol/L), plasma renin activity (PRA), inflammatory cytokines, and the incidence of death or re-hospitalization due to heart failure during 18-months follow up.
Results
Mean age was 71±11 years and mean left ventricular ejection fraction was 33±14%. We
divided patients according to vitamin D levels in tertiles (T1: < 29.6; T2: 29.6-43.9; T3: >43.9). Vitamin D levels were higher in males (P<0.001) and patients with lower age (P=0.002), lower galectin-3 (P<0.001), and lower NT-proBNP (P<0.001). Multivariate linear regression analysis showed that PRA (P=0.033), and C-reactive proteïn (CRP) level (P=0.002) are independent predictors of vitamin D levels. During follow-up, 165 patients died and 142 patients were re-hospitalized. Kaplan-Meier analysis showed that lower vitamin D concentration was associated with an increased risk for all cause mortality (log rank
test P= 0.014) and increased risk for the combined enpoint (mortality and heart failure rehospitalization; log rank test P= 0.045). After adjustment in a multivariable Cox regression analysis, high vitamin D concentration remained independently associated with a decreased risk for all cause mortality (HR 0.61 per nmol/L; 95% CI 0.41-0.91; P=0.015) and the combined endpoint (HR 0.69 per nmol/L; 95% CI 0.51-0.95; P=0.022).
Conclusion
Lower vitamin D concentration is associated with a poorer prognosis in HF patients. Significant correlations between vitamin D, PRA and increased levels of CRP, suggest that the association between vitamin D and outcome is related to RAS-activity and inflammation.