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Is vitamin D deficiency associated with heart failure? A review of current evidence.
J Cardiovasc Pharmacol Ther 2011 Sep-Dec; 16(3-4):354-63JC

Abstract

An estimated 1 billion people worldwide have deficient or insufficient levels of vitamin D. Even more alarming is the association of vitamin D deficiency with many types of diseases, particularly heart failure (HF). Hypovitaminosis D has been observed to be highly prevalent in the HF community with rates varying from approximately 80% to 95%. Higher rates of deficiency have been linked to winter months, in patients with protracted decompensated HF, darker skin pigmentation, and higher New York Heart Association (NYHA) classes. In fact, some data suggest vitamin D deficiency may even be an independent predictor of mortality in patients with HF. Traditionally obtained through UV exposure and activated in the liver and then the kidneys, vitamin D is classified as a vitamin but functions as a steroid hormone. The hormone acts through the vitamin D receptor (VDR), which is expressed in vascular smooth muscle cells, renal juxtaglomerular cells, and most interestingly, cardiac myocytes. Studies have shown that the association between vitamin D deficiency and HF often manifests in the structural components of cardiac myocytes and/or through alterations of the neurohormonal cascade. In addition, vitamin D may also act rapidly through intracellular nongenomic receptors that alter cardiac contractility. Unfortunately, prospective vitamin D supplementation trials show mixed results. In rat models, successful correction of deficiency was associated with reductions in ventricular hypertrophy. In humans, however, echocardiographic dimensions did not change significantly. These results bring into questions whether vitamin D is a risk factor for HF, a marker of HF disease severity, or has a true pathologic role. This article provides a thorough review of vitamin D deficiency etiology, prevalence, and possible pathophysiologic role in HF. Furthermore, we carefully review prospective trials on vitamin D therapy in HF. We believe more trials on vitamin D therapy in HF need to be conducted before any conclusions can be drawn.

Authors+Show Affiliations

Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA. agarwalm@cshs.org

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21304056

Citation

Agarwal, Megha, et al. "Is Vitamin D Deficiency Associated With Heart Failure? a Review of Current Evidence." Journal of Cardiovascular Pharmacology and Therapeutics, vol. 16, no. 3-4, 2011, pp. 354-63.
Agarwal M, Phan A, Willix R, et al. Is vitamin D deficiency associated with heart failure? A review of current evidence. J Cardiovasc Pharmacol Ther. 2011;16(3-4):354-63.
Agarwal, M., Phan, A., Willix, R., Barber, M., & Schwarz, E. R. (2011). Is vitamin D deficiency associated with heart failure? A review of current evidence. Journal of Cardiovascular Pharmacology and Therapeutics, 16(3-4), pp. 354-63. doi:10.1177/1074248410390214.
Agarwal M, et al. Is Vitamin D Deficiency Associated With Heart Failure? a Review of Current Evidence. J Cardiovasc Pharmacol Ther. 2011;16(3-4):354-63. PubMed PMID: 21304056.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is vitamin D deficiency associated with heart failure? A review of current evidence. AU - Agarwal,Megha, AU - Phan,Anita, AU - Willix,Robert,Jr AU - Barber,Mickey, AU - Schwarz,Ernst R, Y1 - 2011/02/08/ PY - 2011/2/10/entrez PY - 2011/2/10/pubmed PY - 2012/2/14/medline SP - 354 EP - 63 JF - Journal of cardiovascular pharmacology and therapeutics JO - J. Cardiovasc. Pharmacol. Ther. VL - 16 IS - 3-4 N2 - An estimated 1 billion people worldwide have deficient or insufficient levels of vitamin D. Even more alarming is the association of vitamin D deficiency with many types of diseases, particularly heart failure (HF). Hypovitaminosis D has been observed to be highly prevalent in the HF community with rates varying from approximately 80% to 95%. Higher rates of deficiency have been linked to winter months, in patients with protracted decompensated HF, darker skin pigmentation, and higher New York Heart Association (NYHA) classes. In fact, some data suggest vitamin D deficiency may even be an independent predictor of mortality in patients with HF. Traditionally obtained through UV exposure and activated in the liver and then the kidneys, vitamin D is classified as a vitamin but functions as a steroid hormone. The hormone acts through the vitamin D receptor (VDR), which is expressed in vascular smooth muscle cells, renal juxtaglomerular cells, and most interestingly, cardiac myocytes. Studies have shown that the association between vitamin D deficiency and HF often manifests in the structural components of cardiac myocytes and/or through alterations of the neurohormonal cascade. In addition, vitamin D may also act rapidly through intracellular nongenomic receptors that alter cardiac contractility. Unfortunately, prospective vitamin D supplementation trials show mixed results. In rat models, successful correction of deficiency was associated with reductions in ventricular hypertrophy. In humans, however, echocardiographic dimensions did not change significantly. These results bring into questions whether vitamin D is a risk factor for HF, a marker of HF disease severity, or has a true pathologic role. This article provides a thorough review of vitamin D deficiency etiology, prevalence, and possible pathophysiologic role in HF. Furthermore, we carefully review prospective trials on vitamin D therapy in HF. We believe more trials on vitamin D therapy in HF need to be conducted before any conclusions can be drawn. SN - 1940-4034 UR - https://www.unboundmedicine.com/medline/citation/21304056/Is_vitamin_D_deficiency_associated_with_heart_failure_A_review_of_current_evidence_ L2 - http://journals.sagepub.com/doi/full/10.1177/1074248410390214?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -