Vitamin D-Parathyroid Hormone-Fibroblast Growth Factor 23 Axis and Cardiac Remodeling

Area of Science:

• Cardiology
• Endocrinology
• Metabolic Diseases

Background:

• Cardiac remodeling is a response to heart failure (HF) that alters heart structure and function.
• Nutritional and metabolic diseases can worsen cardiac remodeling.
• Vitamin D deficiency, hyperparathyroidism, and FGF23 are implicated in cardiac remodeling progression.

Purpose of the Study:

• To explain the effects of vitamin D deficiency, hyperparathyroidism, and FGF23 on cardiac remodeling.
• To highlight the significance of the vitamin D-parathyroid hormone-FGF23 axis in managing heart remodeling.
• To contribute to improved treatment strategies for heart failure patients.

Main Methods:

• Review of existing literature on the roles of vitamin D, parathyroid hormone, and FGF23 in cardiac remodeling.
• Analysis of the pathophysiological mechanisms linking these factors to heart disease.
• Synthesis of evidence regarding the vicious cycle between these factors.

Main Results:

• Vitamin D deficiency activates RAAS, promoting inflammation and fibrosis.
• Hyperparathyroidism exacerbates cardiac remodeling through various pathways, including RAAS activation and oxidative stress.
• FGF23 directly contributes to ventricular hypertrophy and myocardial fibrosis, forming a detrimental cycle with vitamin D deficiency and hyperparathyroidism.

Conclusions:

• The interplay between vitamin D deficiency, hyperparathyroidism, and elevated FGF23 creates a vicious cycle driving cardiac remodeling.
• Targeting this axis offers a potential therapeutic strategy for improving or reversing cardiac remodeling in heart failure.
• Understanding this endocrine-cardiac axis is crucial for advancing HF treatment.