Abstract 20661: Vitamin D Deficiency, Tumor Necrosis Factor-Alpha, and Event-Free Survival in Patients With Heart Failure

Abstract

Background: Vitamin D is related to tumor necrosis factor-alpha (TNF-α), a proinflammatory cytokine that predicts cardiovascular disease. However, whether low vitamin D intake is associated with TNF-α and event-free survival in patients with heart failure (HF) has not been examined. Purpose: To determine whether association of TNF-α with event-free survival differs between patients with vitamin D adequacy and deficiency. Methods: A total of 146 patients with HF (age 63±11 years, 34% female) provided blood to measure serum TNF-α and were divided into 2 groups by median value. Nutrition Analysis program was used to determine intake of vitamin D through a 3-day food diary. Patients with > 80% probability of deficiency were defined as having a diet deficient in vitamin D. Covariate data on age, gender, body mass index, etiology, NYHA class, ejection fraction, comorbidities, and prescribed medications were obtained from review of medical records. Patients were followed for 1 year to determine time to first event of hospitalization or death. Hierarchical logistic and Cox regression was used to address purpose. Results: Eighty-five patients (58%) had vitamin D deficiency. During 1-year, 40 patients (27%) were hospitalized or died. Vitamin D deficiency was associated with higher level of TNF-α (OR=3.10, 95% CI=1.32-7.26). In patients with vitamin D deficiency, higher level of TNF-α (HR=3.08, 95% CI=1.06-8.89) predicted shorter event-free survival after controlling for all covariates, whereas there was no difference in event-free survival between higher and lower level of TNF-α in patients with vitamin D adequacy ( p = .985) . Conclusions: The data suggest that one possible mechanism by which vitamin D deficiency contributed to poor health outcomes is through inflammatory pathways in HF patients. Future study is required to determine whether vitamin D adequacy could play a protective role in the impact of proinflammatory cytokines on event-free survival in HF patients.