title: Calciotropic and phosphaturic hormones in heart failure.
abstract: Despite adherence to evidence-based guidelines, heart failure [HF] still results in 5-year mortality rates of 50%, indicating a need to implement additional preventive/intervention strategies. This review summarizes data on alterations in the calciotropic and phosphaturic hormones 1,25-dihydroxyvitamin D [1,25(OH)2D] and fibroblast growth factors-23 [FGF-23] in HF and discusses non-pharmacological measures for targeting these hormones.
  
  
  
  The role of 1,25(OH)2D in the regulation of calcium and phosphate homeostasis is central. 1,25(OH)2D also plays a pivotal role in cardiac function, but is downregulated by FGF-23. There is accumulating evidence from epidemiological data that HF is associated with decreased circulating 1,25(OH)2D and elevated FGF-23 levels. In patients with failing hearts, very low 1,25(OH)2D and extremely high FGF-23 levels have been reported. Experimental data support the assumption that vitamin D deficiency and high serum phosphate/FGF-23 levels increase the risk of HF. This review provides a hypothesis of how vitamin D deficiency, high calcium/phosphorus intake, physical inactivity, and age-related renal impairment may all contribute to HF by adversely affecting calcium- and phosphate-regulating hormones. Several case series in infants and a meta-analysis of randomized controlled trials in adults have already reported successful treatment of or a significant risk reduction in HF by vitamin D supplements. The association of calcium/phosphorus intake, physical activity, or renal function with calciotropic/phosphaturic hormones and HF is however less well documented.
  
  
  
  More attention should be paid in future to the association of circulating 1,25(OH)2D and FGF-23 levels with HF and to (non-pharmacological) measures for targeting these calciotropic/phosphaturic hormones.
authors: Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Georgstrasse 11, 32545 Bad Oeynhausen, Germany. Electronic address: azittermann@hdz-nrw.de.
authors: A
authors: A
authors: Zittermann
authors: Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Georgstrasse 11, 32545 Bad Oeynhausen, Germany.
authors: J B
authors: JB
authors: Ernst
mesh_terms: D000367:Age Factors; D000818:Animals; D015415:Biomarkers / Q000097:blood; D002136:Calcium, Dietary / Q000009:adverse effects; D019587:Dietary Supplements; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D016226:Phosphorus, Dietary / Q000009:adverse effects; D012307:Risk Factors; D057185:Sedentary Behavior; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D002136:Calcium, Dietary; C000717427:FGF23 protein, human; D016226:Phosphorus, Dietary; D014807:Vitamin D; D005346:Fibroblast Growth Factors; C097949:1,25-dihydroxyvitamin D; D000089703:Fibroblast Growth Factor-23
keywords: 1,25-dihydroxyvitamin D; Calcium; Fibroblast growth factor-23; Heart failure; Parathyroid hormone; Phosphate; Phosphorus; Vitamin D