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J Am Coll Cardiol, 2003; 41:105-112
© 2003 by the American College of Cardiology Foundation
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CLINICAL STUDY: HEART FAILURE

Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure?

Armin Zittermann, PhD*,*, Stefanie Schulze Schleithoff*, Gero Tenderich, MD{dagger}, Heiner K. Berthold, MD, PhD{ddagger}, Reiner Körfer, MD{dagger} and Peter Stehle, PhD*

* Department of Nutrition Science, University of Bonn, Germany
{dagger} Heart and Diabetes Center North Rhine-Westfalia, Department of Thoracic and Cardiovascular Surgery, Ruhr-University of Bochum, Bad Oeynhausen, Germany
{ddagger} Center for Cardiovascular Diseases, Department Clinical Pharmacology, Rotenburg a.d. Fulda, Germany

Manuscript received January 25, 2002; revised manuscript received August 19, 2002, accepted September 13, 2002.

* Reprint requests and correspondence: Dr. Armin Zittermann, Associate Professor, Department of Nutrition Science, University of Bonn, Endenicher Allee 11-13, 53115 Bonn, Germany.
a.zittermann{at}uni-bonn.de

OBJECTIVES: This study was designed to evaluate the association between vitamin D status and congestive heart failure (CHF).

BACKGROUND: Impaired intracellular calcium metabolism is an important factor in the pathogenesis of CHF. The etiology of CHF, however, is not well understood.

METHODS: Twenty patients age <50 years and 34 patients age ≥50 years with New York Heart Association classes ≥2 and 34 control subjects age ≥50 years were recruited. N-terminal pro-atrial natriuretic peptide (NT-proANP), a predictor of CHF severity; vitamin D metabolites; and parameters of calcium metabolism were measured in fasting blood samples collected between November 2000 and March 2001.

RESULTS: Both groups of CHF patients had markedly increased serum levels of NT-proANP (p < 0.001), increased serum phosphorus levels (p < 0.001), and reduced circulating levels of both 25-hydroxyvitamin D (p < 0.001) and calcitriol (p < 0.001). Albumin-corrected calcium levels were reduced and parathyroid hormone levels were increased in the younger CHF patients compared with the controls (both p values <0.001). Moreover, parathyroid hormone levels tended to be higher in the elderly CHF patients than in the controls (p = 0.074). In a nonlinear regression analysis 25-hydroxyvitamin D and calcitriol were inversely correlated with NT-proANP (r2 = 0.16; p < 0.001 and r2 = 0.12; p < 0.01, respectively). The vitamin D genotype at the BmsI restriction site did not differ between the study groups.

CONCLUSIONS: The low vitamin D status can explain alterations in mineral metabolism as well as myocardial dysfunction in the CHF patients, and it may therefore be a contributing factor in the pathogenesis of CHF.

Abbreviations and Acronyms
  Ca2+
  ionized calcium
  CHF
  congestive heart failure
  CI
  cardiac index
  LVEF
  left ventricular ejection fraction
  NT-proANP
  N-terminal pro-ANP
  NYHA
  New York Heart Association
  25OHD
  25-hydroxyvitamin D
  PCWP
  pulmonary wedge pressure
  PTH
  parathyroid hormone
  TNF
  tumor necrosis factor
  UV
  ultraviolet
  VDR
  vitamin D receptor




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