Does preoperative vitamin D supplementation reduce the incidence of postoperative atrial fibrillation in vitamin D deficient or insufficient patients undergoing CABG?
Preoperative vitamin D supplementation significantly reduces the risk of postoperative atrial fibrillation in vitamin D-deficient patients undergoing CABG, but not in those with vitamin D insufficiency.
Postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting (CABG), contributing to increased morbidity, prolonged hospitalization, and elevated healthcare costs. Emerging evidence suggests that vitamin D (Vit. D), via its anti-inflammatory effects and modulation of the renin-angiotensin-aldosterone system (RAAS), may have a cardioprotective role. This systematic review and meta-analysis aimed to evaluate the efficacy of preoperative Vit. D supplementation in reducing the incidence of POAF among CABG patients, with a focus on populations with Vit. D deficiency and insufficiency. Our study was conducted in accordance with the PRISMA 2020 Guidelines. The electronic databases PubMed, Cochrane Library and Google Scholar were searched from 2014 to 2024. Randomized controlled trials and retrospective observational studies involving adult subjects, evaluating Vit. D deficient and/or insufficient patients who have undergone CABG and received Vit. D supplementation in addition to standard care, compared to patients receiving standard care alone or with placebo, and reporting incidence of new-onset POAF were included. Statistical analysis was performed using RevMan v5.4 software, utilizing a random effects model with heterogeneity assessed using the I 2 statistic. A total of four randomized controlled trials were included in our study, evaluating a sample size of 694 (Vitamin D group- 342, Control group- 352; mean age- 61.8 years, 42.6% females). Our meta-analysis revealed that preoperative Vit. D supplementation significantly reduced the incidence of POAF in post-CABG patients with sub-optimal Vit. D levels (RR = 0.55, 95% CI: 0.40–0.76, p = 0.0003, I 2 = 1%). However, no significant effect was noted in the Vit. D insufficient population. Supplementation did not significantly affect length of hospital stay (MD = -0.62, 95% CI: -0.74–0.50, p = 0.28) or duration of intubation (MD = 0.00, 95% CI: -0.26–0.26, p = 0.99). Preoperative Vit. D supplementation appears beneficial in reducing POAF risk in deficient CABG patients, but not in insufficient populations. These findings support targeted supplementation as a potential adjunct in perioperative care, though further large-scale studies are warranted to define optimal dosing strategies and broader applicability.
Lanka et al. (Fri,) studied this question.