Key result
One year of 4000 IU daily vitamin D3 supplementation did not improve 6-minute walk distance but significantly improved left ventricular ejection fraction by 6.07% in patients with chronic heart failure and vitamin D deficiency.
Why the study?
Does vitamin D3 supplementation improve 6-minute walk distance in patients with chronic heart failure, left ventricular systolic dysfunction, and vitamin D deficiency?
RCT (n=229)
Double-blind
Minimisation balancing for aetiology of CHF, diabetes mellitus, sex, COPD, and ethnic origin
Does vitamin D3 supplementation improve 6-minute walk distance in patients with chronic heart failure, left ventricular systolic dysfunction, and vitamin D deficiency?
In patients with heart failure and reduced ejection fraction, high-dose vitamin D3 supplementation for 12 months does not improve 6-minute walk distance but significantly improves left ventricular structure and function.
BACKGROUND: Serum calcium (Ca) and inorganic phosphate (Pi) concentrations and calcium-phosphate product (CPP) levels are positively associated with worse outcomes in patients with chronic kidney disease, but there are few data for Pi or Ca and none for CPP in patients with chronic heart failure (CHF). METHODS: Unselected, consecutive patients with CHF (left ventricular ejection fraction, LVEF ≤45%) were enrolled in a prospective observational study for the occurrence of hospitalisation and mortality. Blood samples were collected at the time of recruitment and analysed immediately. RESULTS: Patients (n = 713) were on contemporary optimal treatment and mean (standard error, SE) follow-up was 765 (18.9) days. Mean (SE) Ca was 2.29 (0.004) mmol/l. Median (interquartile range, IQR) Pi was 1.11 (0.98-1.23) mmol/l and median CPP 2.53 (2.21-2.88) mmol(2)/l(2). LVEF correlated inversely with Ca, natural log-transformed (Ln)Pi, and LnCPP. There was no difference in CPP between classes of symptom severity or diabetes status. Ca and LnCPP (but not LnPi) were associated with total mortality. Ca was significantly associated with progressive HF and non-cardiovascular death but not with sudden death. Binary logistic regression analyses showed that LnPi and LnCPP were associated with risk of hospitalisation. CONCLUSIONS: Ca, Pi and CPP could be useful additional variables in determining risk in CHF patients. Further work is required to elucidate the mechanisms underlying the adverse influence and determine whether lowering phosphate levels per se in CHF patients is of benefit.
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Cubbon et al. (2014) conducted an RCT in Chronic heart failure secondary to left ventricular systolic dysfunction with vitamin D deficiency (n=229). Vitamin D3 (Cholecalciferol) vs. Matching non-calcium-based placebo was evaluated on Change in six-minute walk test distance (6MWT) from baseline to 12 months. One year of 4000 IU daily vitamin D3 supplementation did not improve 6-minute walk distance but significantly improved left ventricular ejection fraction by 6.07% in patients with chronic heart failure and vitamin D deficiency.
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