The role of vitamin D in left ventricular hypertrophy and cardiac function

Abstract

The role of vitamin D in left ventricular hypertrophy and cardiac function. Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). Traditional cardiac risk factors, as well as other factors specific to the ESRD population such as hyperphosphatemia, elevated calcium and phosphate product, abnormal lipid metabolism, hyperhomocysteinemia, and chronic inflammation play a role in the excessive risk of cardiovascular death in this population. Left ventricular disorders are proven risk factors for cardiac mortality in hemodialysis patients. These disorders are present in incident ESRD patients at rates far above the general population. There is an accumulating body of evidence that suggests that vitamin D plays a role in cardiovascular disease. Abnormal vitamin metabolism, through deficiency of the active form of 1,25-dihydroxyvitamin D(3), and acquired vitamin D resistance through the uremic state, have been shown to be important in ESRD. Vitamin D deficiency has long been known to affect cardiac contractility, vascular tone, cardiac collagen content, and cardiac tissue maturation. Recent studies using vitamin D receptor deficient mice as a model demonstrate a crucial role of vitamin D in regulation of the renin-angiotensin system. Additionally, there is emerging evidence linking treatment with vitamin D to improved survival on hemodialysis and improvement in cardiac function. The emergence of this data is focusing attention on the previously underappreciated nonmineral homeostatic effects of vitamin D that very likely play an important role in the pathogenesis of cardiac disease in ESRD.

Major Electrocardiographic Abnormalities and 25‐Hydroxy Vitamin D Deficiency: Insights from National Health and Nutrition Examination Survey‐III

“…17 Vitamin D deficiency has been associated with LVH. 10 The exact mechanisms by which 25-OH vitamin D deficiency would result in an increased prevalence of major ECG abnormalities remains unknown. The major ECG abnormalities analyzed in our study were: Q-QS abnormalities, ST-depression/elevation, negative T waves, Wolff-Parkinson-White syndrome and ventricular conduction delay.…”

“…We performed a subgroup analysis of individuals without LVH (n = 4253), as 25-OH vitamin D deficiency has been associated with LVH. 10 LVH was defined using the Novacode measured left ventricular mass index of >115 grams/m 2 and >130grams/m 2 in females and males, respectively. 26 We further characterized the utility of major ECG abnormalities in predicting long-term all-cause, composite cardiovascular (International Classification of Diseases, 10th Edition [ICD-10] codes I00-I99) (any cardiovascular cause), cardiovascular (ICD-10 codes I20-I25, I60-I69, I70) (ischemic heart disease, atherosclerosis, and cerebrovascular causes), and ischemic heart disease mortality (ICD-10 codes I20-I25) in 25-OH vitamin D sufficient and in the pooled insufficient and deficient groups.…”

“…14 Studies exploring the association of vitamin D with various ECG abnormalities are scarce. 10,17 To the best of our knowledge, the association between vitamin D levels and major ECG abnormalities has not been studied. The present study sought to assess the independent relationship between the 25-hydroxy (25-OH) vitamin D and major ECG abnormalities, and the effect of major ECG abnormalities in individuals with 25-OH vitamin D insufficiency and deficiency on long-term cardiovascular and all-cause mortality in a healthy cohort.…”

“…1 Vitamin D deficiency has been associated with a spectrum of disorders such as diabetes, 2 dysmetabolism, dyslipidemia, 3 hypertension, 4 atherosclerosis, 5 endothelial dysfunction, peripheral vascular disease, 6 congestive heart failure, 7 myocardial infarction, 8 stroke, 9 left ventricular hypertrophy, 10 and cardiovascular disease. 11,12 There is insufficient evidence to warrant supplementing vitamin D to prevent cardiovascular disease.…”

Epidemiology of vitamin D in health and disease

“…70 %) in dialysis patients and some form of vitamin D intake is recommended in those patients (91) . Vitamin D deficiency has been known to affect cardiac contractility, vascular tone, cardiac collagen content and tissue maturation, while treatment with vitamin D improves survival rates in the patients with end-stage renal disease (92) . In a prospective cohort study (follow for 61 (SD 23) months) comparing the risk of death between users (n 162) and non-users (n 80) of oral 1,25(OH) 2 D 3 in a cohort of end-stage renal disease undergoing haemodialysis, the vitamin D users showed a hazard ratio of 0·287 compared with non-users for death from CVD (93) .…”