Supplemental vitamin D and calcium in the management of African Americans with heart failure having hypovitaminosis D

Am J Med Sci. 2011 Feb;341(2):113-8. doi: 10.1097/MAJ.0b013e3182058864.

Abstract

Introduction: A dyshomeostasis of macro- and micronutrients, including vitamin D and oxidative stress, are common pathophysiologic features in patients with congestive heart failure (CHF). In African Americans (AA) with CHF, reductions in plasma 25(OH)D are of moderate-to-marked severity (<20 ng/mL) and may be accompanied by ionized hypocalcemia with compensatory increases in serum parathyroid hormone (PTH). The management of hypovitaminosis D in AA with CHF has not been established.

Methods: Herein, a 14-week regimen: an initial 8 weeks of oral ergocalciferol (50,000 IU once weekly); followed by a 6-week maintenance phase of cholecalciferol (1400 IU daily); and a CaCO₃ (1000 mg daily) supplement given throughout was designed and tested. Fourteen AA patients having a dilated (idiopathic) cardiomyopathy with reduced ejection fraction (EF, <35%) were enrolled: all completed the initial 8-week course; and 12 complied with the full 14 weeks. At baseline, 8 and/or 14 weeks, serum 25(OH)D and PTH; serum 8-isoprostane, a biomarker of lipid peroxidation, and echocardiographic EF were monitored.

Results: Reduced 25(OH)D at entry (14.4 ± 1.3 ng/mL) was improved (P < 0.05) in all patients at 8 weeks (30.7 ± 3.2 ng/mL) and sustained (P < 0.05) at 14 weeks (30.9 ± 2.8 ng/mL). Serum PTH, abnormally increased in 5 patients at baseline (104.8 ± 8.2 pg/mL), was reduced at 8 and 14 weeks (74.4 ± 18.3 and 73.8 ± 13.0 pg/mL, respectively). Plasma 8-isoprostane at entry (136.1 ± 8.8 pg/mL) was reduced at 14 weeks (117.8 ± 7.8 pg/mL; P < 0.05), whereas baseline EF (24.3 ± 1.7%) was improved (31.3 ± 4.3%; P < 0.05).

Conclusions: Thus, the 14-week course of supplemental vitamin D and CaCO₃ led to healthy 25(OH)D levels in AA with heart failure having vitamin D deficiency of moderate-to-marked severity. Albeit a small patient population, the findings suggest that this regimen may attenuate the accompanying secondary hyperparathyroidism and oxidative stress and improve ventricular function.

MeSH terms

  • African Americans
  • Calcium Carbonate / administration & dosage
  • Calcium, Dietary / administration & dosage*
  • Cardiomyopathy, Dilated / blood
  • Cardiomyopathy, Dilated / diet therapy
  • Cardiomyopathy, Dilated / drug therapy
  • Cardiomyopathy, Dilated / etiology
  • Cholecalciferol / administration & dosage
  • Dietary Supplements
  • Dinoprost / analogs & derivatives
  • Dinoprost / blood
  • Ergocalciferols / administration & dosage
  • Female
  • Heart Failure / blood
  • Heart Failure / diet therapy
  • Heart Failure / drug therapy*
  • Heart Failure / etiology*
  • Humans
  • Hyperparathyroidism, Secondary / blood
  • Hyperparathyroidism, Secondary / diet therapy
  • Hyperparathyroidism, Secondary / drug therapy
  • Hyperparathyroidism, Secondary / etiology
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Stroke Volume
  • Vitamin D / administration & dosage*
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / complications*
  • Vitamin D Deficiency / diet therapy
  • Vitamin D Deficiency / drug therapy*

Substances

  • Calcium, Dietary
  • Ergocalciferols
  • Parathyroid Hormone
  • Vitamin D
  • Cholecalciferol
  • 8-epi-prostaglandin F2alpha
  • 25-hydroxyvitamin D
  • Dinoprost
  • Calcium Carbonate