title: Vitamin D reduces left atrial volume in patients with left ventricular hypertrophy and chronic kidney disease.
abstract: BACKGROUND
  Left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular morbidity and mortality. Vitamin D is linked to lower cardiovascular morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. We assessed the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post hoc analysis of the PRIMO trial (clinicaltrials.gov: NCT00497146).
  
  
  RESULTS
  One hundred ninety-six patients with chronic kidney disease (estimated glomerular filtration rate 15-60 mL/min per 1.73 m(2)), mild to moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m(2), 95% CI -4.00 to -1.59 mL/m(2)) in the paricalcitol group compared with the placebo group (-0.70 mL/m(2) [95% CI -1.93 to 0.53 mL/m(2)], P = .002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8% in paricalcitol vs 21.3% in placebo, P = .02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, P = .03).
  
  
  CONCLUSIONS
  Forty-eight weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. In a population where only few therapies alter cardiovascular related morbidity and mortality, these post hoc results warrant further confirmation.
authors.affiliation: Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, USA.
authors.forename: Hector
authors.initials: H
authors.lastname: Tamez
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.forename: David
authors.initials: D
authors.lastname: Packham
authors.forename: Julia
authors.initials: J
authors.lastname: Wenger
authors.forename: Ishir
authors.initials: I
authors.lastname: Bhan
authors.forename: Evan
authors.initials: E
authors.lastname: Appelbaum
authors.forename: Yili
authors.initials: Y
authors.lastname: Pritchett
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.forename: Donald
authors.initials: D
authors.lastname: Lloyd-Jones
authors.forename: Jorge
authors.initials: J
authors.lastname: Cannata
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.forename: Dennis
authors.initials: D
authors.lastname: Andress
authors.forename: Wuyan
authors.initials: W
authors.lastname: Zhang
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Singh
authors.forename: Daniel
authors.initials: D
authors.lastname: Zehnder
authors.forename: Ajay
authors.initials: A
authors.lastname: Pachika
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.forename: Amil
authors.initials: A
authors.lastname: Shah
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Ravi
authors.initials: R
authors.lastname: Thadhani
mesh_terms: D000284:Administration, Oral; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002306:Cardiac Volume / Q000187:drug effects* / Q000502:physiology; D004311:Double-Blind Method; D004452:Echocardiography; D004872:Ergocalciferols / Q000627:therapeutic use*; D005260:Female; D006325:Heart Atria / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D020097:Natriuretic Peptide, Brain; C084656:paricalcitol