Association between Vitamin D and Heart Failure Mortality in 10,974 Hospitalized Individuals.

Kenya Kusunose,Shusuke Yagi,Takeshi Tobiume,Yoko Sumita,Yuichiro Okushi,Miho Abe,Tetsuzo Wakatsuki,Yoshihiro Okayama,Michikazu Nakai,Takayuki Ise,Daiju Fukuda,Takeshi Soeki,Koji Yamaguchi,Hirotsugu Yamada,Robert Zheng,Masataka Sata

doi:10.3390/nu13020335

Abstract

A broad range of chronic conditions, including heart failure (HF), have been associated with vitamin D deficiency. Existing clinical trials involving vitamin D supplementation in chronic HF patients have been inconclusive. We sought to evaluate the outcomes of patients with vitamin D supplementation, compared with a matched cohort using real-world big data of HF hospitalization. This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). After exclusion criteria, we identified 93,692 patients who were first hospitalized with HF between April 2012 and March 2017 (mean age was 79 ± 12 years, and 52.2% were male). Propensity score (PS) was estimated with logistic regression model, with vitamin D supplementation as the dependent variable and clinically relevant covariates. On PS-matched analysis with 10,974 patients, patients with vitamin D supplementation had lower total in-hospital mortality (6.5 vs. 9.4%, odds ratio: 0.67, p < 0.001) and in-hospital mortality within 7 days and 30 days (0.9 vs. 2.5%, OR, 0.34, and 3.8 vs. 6.5%, OR: 0.56, both p < 0.001). In the sub-group analysis, mortalities in patients with age < 75, diabetes, dyslipidemia, atrial arrhythmia, cancer, renin-angiotensin system blocker, and β-blocker were not affected by vitamin D supplementation. Patients with vitamin D supplementation had a lower in-hospital mortality for HF than patients without vitamin D supplementation in the propensity matched cohort. The identification of specific clinical characteristics in patients benefitting from vitamin D may be useful for determining targets of future randomized control trials.

Highlights

The main treatment medications for heart failure (HF) remains to be β-blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone receptor antagonists in the guidelines [1]
Patients with vitamin D supplementation were more likely to have a history of chronic kidney disease, osteoporosis, hypoparathyroidism, or hemodialysis
Mortalities in patients with age < 75 (OR, 0.84, 95% confidence interval (CI): 0.59–1.24, p = 0.54), diabetes (OR, 0.75, 95% CI: 0.56–1.02, p =0.06), dyslipidemia (OR, 0.67, 95% CI: 0.42–1.07, p = 0.09), Af/AFL (OR, 0.79, 95% CI: 0.58–1.07, p = 0.13), cancer (OR, 0.71, 95% CI: 0.47–1.07, p = 0.10), ACEi/angiotensin-receptor blocker (ARB) medication (OR, 0.72, 95% CI: 0.47–1.10, p = 0.13), and β-blocker usage (OR, 0.80, 95% CI: 0.41–1.57, p = 0.51) were not affected by vitamin D supplementation

Summary

Introduction

The main treatment medications for heart failure (HF) remains to be β-blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone receptor antagonists in the guidelines [1]. It is well known that these medications can reduce the incidence of adverse cardiac events and improve cardiac function, HF is still a main cause of death worldwide [2]. Supplementary treatment methods continue to be explored for improving the outcome of HF. Vitamin D is a steroid hormone belonging to a group of lipid-soluble vitamins. Many papers showed that a broad range of chronic conditions have been associated withVitamin vitaminDDisdeficiency Around 90% ofto chronic. HFofpatients have insufficient a steroid [3,4,5].

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Conclusion