title: The association between vitamin D and inflammation with the 6-minute walk and frailty in patients with heart failure.
abstract: OBJECTIVE
  To identify relationships between anabolic hormones, inflammatory markers, and physical function.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Outpatient university heart failure program in Connecticut.
  
  
  METHODS
  Sixty patients with an ejection fraction of 40% or less.
  
  
  METHODS
  The 6-minute walk distance and frailty phenotype were measured. The relationship between physical measures of hormones and inflammatory mediators were examined. Linear and ordinal logistic regression analyses were performed for the physical measures.
  
  
  RESULTS
  Forty-three men (mean age 77 +/- 9) and 17 women (mean age 78 +/- 12) participated. Longer 6-minute walk distance was correlated with higher 25-hydroxyvitamin D (25OHD) level, and a shorter walk was correlated with higher cortisol: dehydroepiandrosterone sulphate (DHEAS) ratio, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL6), and intact parathyroid hormone (PTH) (all P<.05). Percentage of free testosterone, DHEAS alone, and N-terminal pro-brain natriuretic peptide (NTpro-BNP) did not correlate with 6-minute walk distance. Higher frailty phenotype score (more frail) was correlated with higher high-sensitivity CRP, higher IL6, and lower 25OHD levels (all P<.05). Linear regression with the 6-minute walk distance as the dependent variable and independent variables of age, sex, percentage of free testosterone, DHEAS, 25OHD, intact PTH, hsCRP, IL6, cortisol/DHEAS ratio, and NTpro-BNP, revealed age, sex, 25OHD and hsCRP to be significant (coefficient of determination=53.5%). Ordinal logistic regression with the frailty phenotype and hormonal levels revealed that age, 25OHD, and hsCRP also predicted frailty status.
  
  
  CONCLUSIONS
  Twenty-five-hydroxyvitamin D and hsCRP levels may contribute to lower aerobic capacity and frailty in patients with heart failure. A longitudinal study will further define the role of 25OHD and hsCRP on muscle strength and functional decline.
authors.affiliation: Department of Family Medicine, Case Western University Hospital, Cleveland, Ohio 44106, USA. Rebecca.Boxer@uhhospitals.org
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Boxer
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Dauser
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Walsh
authors.forename: W David
authors.initials: WD
authors.lastname: Hager
authors.forename: Anne M
authors.initials: AM
authors.lastname: Kenny
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D016330:Frail Elderly; D006304:Health Status; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D016138:Walking / Q000502:physiology
chemical_list: D015850:Interleukin-6; D014807:Vitamin D; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D