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Published on: March 29, 2024
Role of Vitamin D in Patients with Heart Failure with Reduced Ejection Fraction
Meifang Wu1, Kaizu Xu1, Ying Wu2
1Department of Cardiology, Affiliated Hospital of Putian University, Putian, 351100, Fujian, China.
Insights
Vitamin D deficiency is common in heart failure with reduced ejection fraction (HFrEF) and linked to worse outcomes. Supplementation trials show inconsistent results, highlighting the need for further research in HFrEF patients.
Area of Science:
- Cardiology
- Endocrinology
- Nutritional Science
Background:
- Heart failure with reduced ejection fraction (HFrEF) remains a significant health burden despite treatment advances.
- Vitamin D deficiency is prevalent in HFrEF patients and associated with poor clinical outcomes.
- Vitamin D's role in cardiac health involves the vitamin D receptor in cardiomyocytes.
Purpose of the Study:
- To review the epidemiology of vitamin D deficiency in heart failure (HF).
- To explore the pathophysiology linking vitamin D deficiency to HFrEF.
- To analyze the prognostic value and randomized controlled trial (RCT) outcomes of vitamin D supplementation in HFrEF.
Main Methods:
- Review of epidemiological data on vitamin D deficiency in HF.
- Examination of mechanistic pathways implicating vitamin D in HFrEF pathophysiology.
- Analysis of published randomized controlled trials on vitamin D supplementation in HFrEF.
Main Results:
- Vitamin D deficiency is highly prevalent in HFrEF.
- Potential pathophysiological mechanisms include renin-angiotensin system activation, inflammation, and impaired calcium handling.
- RCTs of vitamin D supplementation in HFrEF have yielded inconsistent clinical outcomes.
Conclusions:
- Vitamin D deficiency is a significant issue in HFrEF with potential pathophysiological links.
- The clinical benefit of vitamin D supplementation in HFrEF requires further investigation due to inconsistent trial results.
Abstract:
Heart failure (HF) with reduced ejection fraction (HFrEF) presents as the severest phenotype on the spectrum of HF. Although great progress has been made with respect to its treatment over the past 3 decades, morbidity and mortality remain high, posing a big burden on human health. Recent evidence suggests vitamin D has a critical role in maintaining heart health through activation of the vitamin D receptor expressed in cardiomyocytes, and vitamin D deficiency may be implicated in the pathophysiology of HFrEF through activation of the renin-angiotensin system, impaired calcium handling, exaggerated inflammation, secondary hyperparathyroidism, pro-fibrotic properties, and proatherogenic potential. Additionally, epidemiological data disclosed that vitamin D deficiency is highly prevalent in patients with HFrEF and is associated with poor clinical outcomes. However, randomized control trials of vitamin D supplementation in HF, especially in HFrEF, have shown inconsistent results. Thus, this article aims to review the epidemiology, pathophysiology, and prognostic value of vitamin D deficiency in HF, with a special focus on randomized control trials associated with vitamin D supplementation in patients with HFrEF.
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