I will always remember a young man I treated when I was a general practitioner in West Virginia. He was a coal miner working on the day shift before he got sick. For unknown reasons he developed cardiomyopathy and was in congestive heart failure (CHF). Nothing the cardiologist or I did seemed to stop his slow deterioration. He eventually died of idiopathic cardiomyopathy at age 26 leaving a wife and two young children. Today, he would have had a heart transplant. But why did his heart fail?
Despite the advances in understanding the pathophysiology and treatment, CHF still has a poor prognosis. Only 35% of patients will survive 5 years. In the USA, heart failure is much higher in those with darker skin, such as African Americans, Hispanics, and Native Americans. Emergency room visits for CHF peak in December and are at their lowest in August.
You may remember the amazing randomized controlled trial of vitamin D in infant heart failure.
Recently, Doctor Ahmad Amin and colleagues, working under the supervision of senior author Doctor Maryam Ardeshiri, studied vitamin D in congestive heart failure.
In an open trial, they gave 100 patients with congestive heart failure 50,000 IU/week of D3 for 2 months followed by 50,000 IU/month for two months. Fifty-five of the 100 patients had what my patient had, cardiomyopathy. All the 100 patients had vitamin D levels less than 30 ng/ml to begin.
After supplementation, 25 (OH) D only increased by 17 ng/ml. Mean 25(OH)D levels went from 5 ng/ml to 22 ng/ml. Vitamin D supplementation decreased mean serum parathyroid hormone concentrations by 36.73 ng/L (P<.001). Surprisingly, they also found a 1.44-mg/dL decrease (not increase) in serum calcium (<.001). A marker of inflammation, high sensitivity C-reactive protein, decreased from 17 to 11 mg/dL (P<.001).
During 12 weeks of treatment with vitamin D, mean heart failure functional class in the study population improved significantly (P<.001). Ejection fraction also improved significantly (P<.001). Exercise tolerance as measured by the six minute walk test improved significantly (P<.001). They also found a large decrease in a marker for congestive heart failure called pro–brain natriuretic peptide (proBNP) from 25080 to 1681 pg/ml. Various ultrasound measurements of the heart improved significantly.
The authors concluded:
“The results of our study indicate that an appropriate strategy of vitamin D supplementation decreases the severity of heart failure, reflected in the reduction of serum proBNP. We also demonstrated that vitamin D causes a pronounced improvement in physical capacity of patients. Moreover, vitamin D was able to suppress the concentration of high sensitivity C reactive protein. Our data provide valuable evidence for the efficacy of vitamin D supplementation in the optimal management of heart failure.”