Abstract
BackgroundNutritional vitamin D deficiency is an emerging risk factor for acute myocardial infarction (AMI) and heart failure. The association of 25-hydroxyvitamin D levels with N-terminal pro B-type natriuretic peptide (NT-proBNP), a robust prognostic marker for post-AMI mortality and heart failure, is unknown and could illuminate a potential pathway for adverse outcomes among post-AMI patients with 25-hydroxyvitamin D deficiency.MethodsIn a cross-sectional analysis, we studied 238 AMI patients from 21 U.S. centers to test the association of nutritional vitamin D (25-hydroxyvitamin D [25(OH)D]) deficiency with NT-proBNP levels. Levels of 25(OH)D levels were categorized as normal (≥30 ng/mL), insufficient (>20 - <30 ng/mL), deficient (>10 - ≤20 ng/mL), or severely deficient (≤10 ng/mL).ResultsLow 25(OH)D levels were found in 95.7% of AMI patients. No significant trends for higher mean baseline log NT-proBNP levels in severely deficient (6.9 ± 1.3 pg/mL), deficient (6.9 ± 1.2 pg/mL), and insufficient (6.9 ± 0.9 pg/ml) groups were observed as compared with patients having normal (6.1 ± 1.7 pg/mL) levels, P = 0.17. Findings were similar in the subset of patients who had follow-up NT-proBNP levels drawn at one month. In multivariate regression modeling, after adjusting for multiple covariates, 25(OH)D was not associated with NT-proBNP.ConclusionsPotential associations between nutritional vitamin D deficiency and prognosis in the setting of AMI are unlikely to be mediated through NT-proBNP pathways. Future studies should examine other mechanisms, such as inflammation and vascular calcification, by which 25(OH)D deficiency could mediate adverse outcomes post-AMI.
Highlights
Nutritional vitamin D deficiency is an emerging risk factor for acute myocardial infarction (AMI) and heart failure
In this cross-sectional observational study, we found no evidence of an association between levels of 25(OH)D and NT-proBNP upon discharge, nor was there evidence of an association at one month in the subset of tested patients. This is the first study to examine levels 25(OH)D and NT-proBNP in an AMI population. While both 25(OH)D and NT-proBNP levels are associated with cardiovascular disease and heart failure, they appear to impact prognosis through different mechanisms in the setting of AMI
We extend our previous findings [29] in this AMI cohort by showing that 25(OH)D levels are associated with smoking, lower degrees of physical activity, and lesser use of omega-3 supplements in bivariate analysis, consistent with previous reports [1,31,35]
Summary
Nutritional vitamin D deficiency is an emerging risk factor for acute myocardial infarction (AMI) and heart failure. 25(OH)D deficiency has been independently associated with both incident acute myocardial infarction (AMI) and heart failure (HF) [4,5], suggesting that 25(OH)D plays an important role in cardiac function. In support of this hypothesis, several in vitro studies have shown that calcitriol (1,25(OH)2D3), function as compared with placebo [14]. These findings suggest that low circulating levels of 25 (OH)D could contribute to, or potentiate, the development of left ventricular dysfunction and HF after AMI. NT-proBNP levels have direct clinical implications, as they are used to guide therapeutic interventions in HF patients and lead to improved outcomes as compared with routine clinical treatment [24]
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