HFSA: Vitamin D Marker for HF Deaths
By Charles Bankhead, Staff Writer, MedPage Today, September 16, 2010
http://www.medpagetoday.com/MeetingCoverage/HFSA/22250
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
SAN DIEGO — Heart failure death occurred two to three times more often in people with vitamin D insufficiency or deficiency compared with those who had normal levels of the vitamin, according to data from a government survey.
Vitamin D deficiency — defined as serum 25-hydroxyvitamin D (25OHD)<20 ng/mL — increased the odds for heart failure death to 3.4 compared with people who had normal serum levels ?30 ng/mL. Vitamin D insufficiency — serum 25-hydroxyvitamin D of 20 to 29 ng/mL — doubled the heart failure mortality risk.
People who died of heart failure were almost 50% more likely to be vitamin-D deficient compared with people who died of other causes, as reported here at the Heart Failure Society of America meeting.
Premature mortality, defined as death before age 75, also had a significant association with vitamin D deficiency and insufficiency.
"These data may represent yet additional justification for the idea of studying vitamin D supplementation in appropriate patients to determine whether a causal relationship exists and whether this is a potentially treatable condition," said Howard J. Eisen, MD, of Drexel University in Philadelphia.
Recent studies have implicated vitamin D deficiency in several medical conditions, but few investigations have examined associations between vitamin D and heart failure. To inform on the issue, Eisen and colleagues analyzed data from the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994.
The analysis comprised data on 13,131 adults ages 35 and older, followed for a median of eight years through 2000. Serum 25(OH)D was measured at enrollment by radioimmunoassay.
Investigators examined associations between vitamin D status and mortality, both heart failure and all-cause mortality. They also studied vitamin D status in patients who died prematurely.
The data showed vitamin D deficiency in 20% of Caucasians, 60% of African Americans, and almost 40% of Mexican Americans and other racial/ethnic groups. About 35% of Caucasians had vitamin D insufficiency, as did almost 30% of African Americans, and almost 40% of Mexican Americans and other racial/ethnic groups.
During follow-up, 3,266 participants died, including 101 heart failure deaths. Premature deaths accounted for 1,066 (33%) of all deaths.
Among participants who died of heart failure, 37% had vitamin D deficiency compared with 26% of participants who died of causes other than heart failure (P<0.001).
In a Cox regression model adjusted for age, sex, race, and medical conditions, vitamin D deficiency conferred an odds ratio for heart failure death of 3.4 compared with study participants who had normal 25(OH)D levels (P<0.001). Vitamin D insufficiency was associated with a heart failure mortality odds ratio of 2.0.
The relative risk of premature death rose to 1.45 for participants with vitamin D deficiency and to 1.14 for the association with vitamin D insufficiency (P<0.001 for trend).
Eisen stated that he had no relevant disclosures.
Source reference: Liu L, et al "Serum 25-hydroxyvitamin D concentraton: Heart failure mortality and premature death from all cause in U.S. adults: An eight-year follow-up study" HFSA 2010; Abstract 018.