Prevalence of Micronutrient Deficiencies and Relationship with Clinical and Patient-Related Outcomes in Pulmonary Hypertension Types I and IV

Abstract

Background: Pulmonary hypertension (PH) is a rare progressive and lethal disease affecting pulmonary arteries and heart function. The disease may compromise the nutritional status of the patient, which impairs their physical performance. This study aimed to determine the prevalence of micronutrient deficiencies in pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH) patients. Methods: Eighty-one blood samples from a prospective observational cohort study were analyzed for concentrations of micronutrients and inflammation-related factors. The samples consisted of newly diagnosed (treatment-naive) PAH and CTEPH patients and patients treated for 1.5 years according to ERS/ESC guidelines. Results: In the newly diagnosed group, 42% of PAH patients and 21% of CTEPH patients were iron deficient compared to 29% of PAH patients and 20% of CTEPH patients in the treatment group. Vitamin D deficiency occurred in 42% of the newly diagnosed PAH patients, 71% of the newly diagnosed CTEPH patients, 68% of the treated PAH patients, and 70% of the treated CTEPH patients. Iron levels correlated with the 6 min walking distance (6MWD). Conclusions: Iron and vitamin D deficiencies are highly prevalent in PAH and CTEPH patients, underlining the need for monitoring their status. Studies evaluating the effects of supplementation strategies for iron and vitamin D are necessary.

An inverse causal relationship between serum 25‐hydroxyvitamin D levels and pulmonary hypertension: A two‐sample Mendelian randomization study

“…Recently, more and more researches have explored the relationship between 25(OH)D and PH. The present study further validated the conclusions of prior observational studies, where the levels of serum vitamin D were lower in patients with PH compared to healthy individuals and approximately 68% of PH patients were diagnosed with vitamin D deficiency 8,30 . In addition, lower serum 25(OH)D levels can predict poor prognosis for patients with PH 31 .…”

Nutritional status in pulmonary arterial hypertension

“…Although overall vitamin and mineral status was preserved in the majority of patients, in a subset of patients values below reference could be observed. As previously described by us and others, 32% of patients had an iron deficiency and 43% a vitamin D deficiency 3–6 . An iron deficiency is common in heart failure, 23 and a vitamin D deficiency is described as a worldwide problem 24 .…”

“…had an iron deficiency and 43% a vitamin D deficiency. [3][4][5][6] An iron deficiency is common in heart failure, 23 and a vitamin D deficiency is described as a worldwide problem. 24 In 60% of our patients vitamin K1 deficiency was observed.…”

“…Although malnutrition is well recognized in end-stage disease, so far little is known of the nutritional status in PAH patients who are stable under treatment. While iron and vitamin D deficiencies have been described in PAH, [3][4][5][6] until now a comprehensive description of the nutritional status in PAH patients with vitamin and mineral status and nutritional intake is lacking. As a consequence, no evidence based dietary recommendations are available.…”

Perioperative Management in Pulmonary Endarterectomy

“…59,60 Although most patients with CTEPH undergoing PEA surgery have normal hemoglobin or mild erythrocytosis, up to 20% of patients can suffer iron deficiency which should be investigated and treated before surgery. 61,62 Hemoglobinopathies and abnormal red cell membrane disorders such as sickle cell, HbC trait, or thalassemia are associated with CTEPH. Patients with hemoglobinopathies need specific classification before surgery and a 100% HbA allogenic blood units should be available for transfusion.…”