Vitamin D Treatment Attenuates Heart Apoptosis After Coronary Artery Bypass Surgery: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial

Abstract

Background: Vitamin D plays an important role in immune system and in the regulation of inflammatory cytokines. Coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) is associated with an extensive inflammatory response. The aim of this study is to examine the effect of vitamin D treatment on the apoptosis and inflammatory changes developed after CABG. Methods: This trial was conducted on 70 patients undergoing CABG with CPB. Patients were randomly administered either in placebo or in the group of orally consuming 150 000 IU vitamin D daily for 3 consecutive days before surgery. The right atrium sample was taken to assess caspases 2, 3, and 7 activity using immunohistochemistry method. The serum level of interleukin-10 (IL-10) and insulin-like growth factor 1 (IGF-1) were compared at intervals. Results: The average number of positive cells for caspases 2 and 3 were less in vitamin D group ( P = .006 and P < .001, respectively). There was an increase in serum levels of IL-10 after 3 days from vitamin D treatment before surgery (vitamin D group = 4.4 ± 4.9 ng/mL and control group = 1 ± 0.5 ng/mL, P = .001). After operation, IL-10 increased in both groups, higher level in vitamin D group ( P < .001). The comparison of serum IGF-1 showed significant difference after 3 days ( P = .006) and remained higher in vitamin D group after CPB ( P < .001). Conclusions: These findings suggest the apoptosis rate after CPB can be reduced by vitamin D. Vitamin D treatment may improve the inflammatory status before and after surgery. Further studies are needed to confirm the antiapoptotic property of vitamin D and clinical implication.

The effect of vitamin D levels on clinical outcomes after pediatric open-heart surgery

“…This study aligns with prior research and the current study's findings. Tasdighi et al (2020) showed that the apoptosis rate after CPB can be reduced with vitamin D. Vitamin D treatment may improve the inflammatory condition before and after surgery. Accordingly, it is recommended that patients' vitamin D levels be adjusted as much as possible before surgery to reduce treatment costs and other risks (15).…”

“…Tasdighi et al (2020) showed that the apoptosis rate after CPB can be reduced with vitamin D. Vitamin D treatment may improve the inflammatory condition before and after surgery. Accordingly, it is recommended that patients' vitamin D levels be adjusted as much as possible before surgery to reduce treatment costs and other risks (15). Kendrick et al's study (2008) showed in that the risk of developing angina, myocardial infarction, and heart failure is higher in people with vitamin D levels< 20 ng/ml ( 16) additionally, a study by Kim et al (2008) also showed that reducing vitamin D levels<20 ng/ml increased the incidence of coronary heart disease, heart failure, and peripheral vascular disease (17).…”

Association Between the Circulating Level of 25-Hydroxyvitamin D and Clinical Results After Cardiac Surgery: A Meta-Analysis and Systematic Review

“…Cerit et al ( 36 ) demonstrated an obvious improvement in PO-AF prevalence in patients with VitD deficiency after cardiac surgery between a VitD-supplementation group and control group (18 vs. 29%) ( P = 0.02). In addition, VitD treatment may improve the inflammatory status, reduce the apoptosis rate, and regulate the renin–angiotensin–aldosterone system and electromechanical system of the left atrium ( 36 , 56 ).…”

Vitamin D for inflammation biomarkers in coronary artery disease

“…Some clinical studies found that VD could effectively treat cardiovascular disease and has been used in some clinical practice. [ 16 , 17 ] But there is no systematic review regarding its effect and safety so far. Therefore, we will perform this high-quality research with the aim of providing a vigorous proof of effectiveness and safety for clinical strategy and health policymakers.…”