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Evaluating Vitamin D levels in Rheumatic Heart Disease patients and matched controls: A case-control study from Nepal
Lene Thorup1,2, Sophie Amalie Hamann2, Ashish Tripathee3
1Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark.
Insights
Rheumatic Heart Disease (RHD) patients in Nepal show lower Vitamin D levels and poorer nutritional status. Vitamin D insufficiency is linked to a higher risk of developing RHD.
Area of Science:
- Cardiology
- Nutritional Science
- Immunology
Background:
- Rheumatic Heart Disease (RHD) affects millions globally, particularly in low-income countries, with limited access to diagnosis and treatment.
- Understanding RHD risk factors and disease mechanisms is crucial for prevention and improved treatment strategies.
- This study specifically investigated the role of Vitamin D deficiency, known for its immunomodulatory effects, as a potential risk factor for RHD in Nepal.
Purpose of the Study:
- To investigate risk factors associated with Rheumatic Heart Disease (RHD) in a Nepalese population.
- To examine the specific association between Vitamin D deficiency and RHD.
- To evaluate the nutritional status of RHD patients compared to healthy controls.
Main Methods:
- Recruited 99 RHD patients and 97 healthy controls from Nepalese hospitals.
- Assessed serum 25(OH)D concentrations using dried blood spots and measured anthropometric values.
- Employed conditional logistic regression analysis to determine the link between Vitamin D deficiency and RHD.
Main Results:
- RHD patients exhibited lower mean Vitamin D levels (39 nmol/l) compared to controls (45 nmol/l).
- Vitamin D insufficiency was associated with a 2.59 times higher risk of RHD (OR = 2.59; 95% CI: 1.04-6.50).
- RHD patients had significantly lower Body Mass Index (BMI) than controls, indicating poorer nutritional status.
Conclusions:
- Nepalese RHD patients demonstrate lower Vitamin D levels and compromised nutritional status compared to non-RHD individuals.
- Further longitudinal studies are required to establish causality between RHD and Vitamin D levels.
- Research is recommended to confirm the widespread low Vitamin D levels observed in the general Nepalese population.
Background:
Diagnosis and treatment for Rheumatic Heart Disease (RHD) is inaccessible for many of the 33 million people in low and middle income countries living with this disease. More knowledge about risk factors and pathophysiologic mechanisms involved is needed in order to prevent disease and optimize treatment. This study investigated risk factors in a Nepalese population, with a special focus on Vitamin D deficiency because of its immunomodulatory effects.
Methods:
Ninety-nine patients with confirmed RHD diagnosis and 97 matched, cardiac-healthy controls selected by echocardiography were recruited from hospitals in the Central and Western region of Nepal. Serum 25(OH)D concentrations were assessed using dried blood spots and anthropometric values measured to evaluate nutritional status. Conditional logistic regression analysis was used to define association between vitamin D deficiency and RHD.
Results:
The mean age of RHD patients was 31 years (range 9-70) and for healthy controls 32 years (range 9-65), with a 4:1 female to male ratio. Vitamin D levels were lower than expected in both RDH and controls. RHD patients had lower vitamin D levels than controls with a mean s-25(OH)D concentration of 39 nmol/l (range 8.7-89.4) compared with controls 45 nmol/l (range 14.5-86.7) (p-value = 0.02). People with Vitamin D insufficiency had a higher risk (OR = 2.59; 95% CI: 1.04-6.50) of also having RHD compared to people with Vitamin D concentrations >50 nmol/l. Body mass index was significantly lower in RHD patients (22.6; 95% CI, 21.5-23.2) compared to controls (24.2; 95% CI, 23.3-25.1).
Conclusion:
RHD patients in Nepal have lower Vitamin D levels and overall poor nutritional status compared to the non-RHD controls. Longitudinal studies are needed to explore the causality between RHD and vitamin D level. Future research is also recommended among Nepali general population to confirm the low level of vitamin D as reported in our control group.
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