Supplemental vitamin D and calcium in the management of African Americans with heart failure having hypovitaminosis D.
BACKGROUND
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.
Department of Medicine, University of Tennessee Health Science Center, Memphis, 38163, USA.
Ayhan A
AA
Zia
Babatunde O
BO
Komolafe
Marriyam
M
Moten
Robert A
RA
Ahokas
Jesse E
JE
McGee
E
E
William Rosenberg
Syamal K
SK
Bhattacharya
Karl T
KT
Weber
D001741:Black or African American; D002119:Calcium Carbonate / Q000008:administration & dosage; D002136:Calcium, Dietary / Q000008:administration & dosage*; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology; D002762:Cholecalciferol / Q000008:administration & dosage; D019587:Dietary Supplements; D015237:Dinoprost / Q000031:analogs & derivatives / Q000097:blood; D004872:Ergocalciferols / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D013318:Stroke Volume; D014807:Vitamin D / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000178:diet therapy / Q000188:drug therapy*
D002136:Calcium, Dietary; D004872:Ergocalciferols; D010281:Parathyroid Hormone; D014807:Vitamin D; D002762:Cholecalciferol; C075750:8-epi-prostaglandin F2alpha; C104450:25-hydroxyvitamin D; D015237:Dinoprost; D002119:Calcium Carbonate