Vitamin D deficiency among patients with pulmonary hypertension

Atamañuk, Andrés N.; Litewka, Diego; Baratta, Sergio; Seropián, Ignacio M.; Prados, Graciela Perez; Payaslian, Miguel; Fragola, Juan P. Ortiz; Escribano, Pilar

doi:10.1186/s12890-019-1011-7

Cited by 19 publications

(14 citation statements)

References 30 publications

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“…Values were very similar for idiopathic (class 1.1) and heritable PAH (class 1.2), and the sample of the drug-induced PAH (class 1.3) was too small to draw any conclusion. In a recent published study, 25(OH)vitD levels from PH patients with different etiologies were also analyzed as a single group [34].…”

Section: Discussionmentioning

confidence: 99%

Total, Bioavailable, and Free Vitamin D Levels and Their Prognostic Value in Pulmonary Arterial Hypertension

Callejo

Mondéjar-Parreño

Esquivel-Ruiz

et al. 2020

JCM

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Introduction: Epidemiological studies suggest a relationship between vitamin D deficiency and cardiovascular and respiratory diseases. However, whether total, bioavailable, and/or free vitamin D levels have a prognostic role in pulmonary arterial hypertension (PAH) is unknown. We aimed to determine total, bioavailable, and free 25-hydroxy-vitamin D (25(OH)vitD) plasma levels and their prognostic value in PAH patients. Methods: In total, 67 samples of plasma from Spanish patients with idiopathic, heritable, or drug-induced PAH were obtained from the Spanish PH Biobank and compared to a cohort of 100 healthy subjects. Clinical parameters were obtained from the Spanish Registry of PAH (REHAP). Results: Seventy percent of PAH patients had severe vitamin D deficiency (total 25(OH)vitD < 10 ng/mL) and secondary hyperparathyroidism. PAH patients with total 25(OH)vitD plasma above the median of this cohort (7.17 ng/mL) had better functional class and higher 6-min walking distance and TAPSE (tricuspid annular plane systolic excursion). The main outcome measure of survival was significantly increased in these patients (age-adjusted hazard ratio: 5.40 (95% confidence interval: 2.88 to 10.12)). Vitamin D-binding protein (DBP) and albumin plasma levels were downregulated in PAH. Bioavailable 25(OH)vitD was decreased in PAH patients compared to the control cohort. Lower levels of bioavailable 25(OH)vitD (<0.91 ng/mL) were associated with more advanced functional class, lower exercise capacity, and higher risk of mortality. Free 25(OH)vitD did not change in PAH; however, lower free 25(OH)vitD (<1.53 pg/mL) values were also associated with high risk of mortality. Conclusions: Vitamin D deficiency is highly prevalent in PAH, and low levels of total 25(OH)vitD were associated with poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Total, Bioavailable, and Free Vitamin D Levels and Their Prognostic Value in Pulmonary Arterial Hypertension

Callejo

Mondéjar-Parreño

Esquivel-Ruiz

et al. 2020

JCM

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“…To prevent bone fractures, treatment of vitD deficiency is mandatory to restore calcium and bone homeostasis. Because lower 25(OH)vitD levels vitD are associated with worse prognosis in PAH patients [18,[20][21][22][23], we speculate that restoring vitD status may improve their lung pathology, besides improving their bone and muscular health.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, we [18] and others [19][20][21][22][23] have demonstrated that vitD deficiency is much more frequent in PAH than in the general population. Insufficient levels, i.e., 25(OH)vitD < 20 ng/mL, are present in up to 95% of the patients and a severe deficit, i.e., 25(OH)vitD < 10 ng/mL, with subsequent secondary hyperparathyroidism is observed in 70% of them.…”

Section: Introductionmentioning

confidence: 99%

“…Insufficient levels, i.e., 25(OH)vitD < 20 ng/mL, are present in up to 95% of the patients and a severe deficit, i.e., 25(OH)vitD < 10 ng/mL, with subsequent secondary hyperparathyroidism is observed in 70% of them. Furthermore, lower levels of vitD are associated with worse functional class, higher levels of BNP/proBNP, reduced 6-min-walking-distance (6MWD), increased mPAP, increased pulmonary vascular resistance, decreased cardiac output and/or reduced survival [18,19,21,22].…”

Section: Introductionmentioning

confidence: 99%

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Restoration of Vitamin D Levels Improves Endothelial Function and Increases TASK-Like K+ Currents in Pulmonary Arterial Hypertension Associated with Vitamin D Deficiency

et al. 2021

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Background: Vitamin D (vitD) deficiency is highly prevalent in patients with pulmonary arterial hypertension (PAH). Moreover, PAH-patients with lower levels of vitD have worse prognosis. We hypothesize that recovering optimal levels of vitD in an animal model of PAH previously depleted of vitD improves the hemodynamics, the endothelial dysfunction and the ionic remodeling. Methods: Male Wistar rats were fed a vitD-free diet for five weeks and then received a single dose of Su5416 (20 mg/Kg) and were exposed to vitD-free diet and chronic hypoxia (10% O2) for three weeks to induce PAH. Following this, vitD deficient rats with PAH were housed in room air and randomly divided into two groups: (a) continued on vitD-free diet or (b) received an oral dose of 100,000 IU/Kg of vitD plus standard diet for three weeks. Hemodynamics, pulmonary vascular remodeling, pulmonary arterial contractility, and K+ currents were analyzed. Results: Recovering optimal levels of vitD improved endothelial function, measured by an increase in the endothelium-dependent vasodilator response to acetylcholine. It also increased the activity of TASK-1 potassium channels. However, vitD supplementation did not reduce pulmonary pressure and did not ameliorate pulmonary vascular remodeling and right ventricle hypertrophy. Conclusions: Altogether, these data suggest that in animals with PAH and severe deficit of vitD, restoring vitD levels to an optimal range partially improves some pathophysiological features of PAH.

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“…Researchers are aware that the role of vitamin D is not just limited to bone health, however, its role outside bone health is poorly understood. Research has shown that vitamin D deficiency has a negative impact on morbidity and mortality outcomes in patients who have chronic illnesses such as heart disease, diabetes mellitus, cancer, pulmonary hypertension, and auto-immune disorders [ 4 - 5 ]. Unfortunately, none of the current evidence was able to explain the association between vitamin D deficiency and these chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

Role of Vitamin D Supplementation in Heart Failure Patients With Vitamin D Deficiency and Its Effects on Clinical Outcomes: A Literature Review

Busa

Dardeir

Marudhai

et al. 2020

Cureus

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Vitamin D deficiency has become a global pandemic affecting approximately one billion people worldwide. Much attention has been paid to the association of low serum 25-hydroxyvitamin D (25(OH)D) levels and various chronic diseases, especially heart failure (HF). A clear role of vitamin D deficiency has been established, with increased mortality and morbidity in heart failures. However, previous randomized control trials have failed to show improvement in clinical outcomes with calciferol supplementation in these patients. Therefore, it is still unclear whether calciferol therapy can be added to the standard care in congestive heart failure (CHF) patients with deficiency. Hence, to evaluate the role of vitamin D supplementation in CHF patients with low serum 25(OH)D, we conducted an extensive search in the PubMed and Google Scholar databases using various combinations of keywords. All potentially eligible studies that evaluated the effects of vitamin D supplementation on clinical outcomes in HF patients were retrieved and extensively studied. We also checked the references of all eligible studies to identify additional relevant publications. In this study, we reviewed various mechanisms of vitamin D affecting the cardiovascular system and examined the impact of deficiency on heart failures in terms of mortality and hospitalizations. In conclusion, vitamin D supplementation has failed to improve the clinical outcomes in HF patients. The possible long-term benefits of supplementation cannot be excluded. Therefore, for future clinical trials, we recommend considering large sample sizes, longer follow-up durations, along with optimal dosage and appropriate dosing frequency.

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Vitamin D deficiency among patients with pulmonary hypertension

Cited by 19 publications

References 30 publications

Total, Bioavailable, and Free Vitamin D Levels and Their Prognostic Value in Pulmonary Arterial Hypertension

Total, Bioavailable, and Free Vitamin D Levels and Their Prognostic Value in Pulmonary Arterial Hypertension

Restoration of Vitamin D Levels Improves Endothelial Function and Increases TASK-Like K+ Currents in Pulmonary Arterial Hypertension Associated with Vitamin D Deficiency

Role of Vitamin D Supplementation in Heart Failure Patients With Vitamin D Deficiency and Its Effects on Clinical Outcomes: A Literature Review

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