PMID- 26702277
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20151224
LR  - 20201001
IS  - 1731-5530 (Print)
IS  - 1897-4252 (Electronic)
IS  - 1731-5530 (Linking)
VI  - 12
IP  - 3
DP  - 2015 Sep
TI  - Clinical and laboratory determinants of low serum level of 25-hydroxyvitamin D 
      during escalation of pharmacotherapy in heart failure patients.
PG  - 216-27
LID - 10.5114/kitp.2015.54457 [doi]
AB  - INTRODUCTION: The activation of the renin-angiotensin-aldosterone (RAA) system is 
      a main element of the pathophysiology of chronic heart failure (CHF), determining 
      its symptoms and prognosis. Vitamin D is an RAA inhibitor, and its deficiency 
      frequently accompanies CHF. The factors determining the concentration of 
      25-hydroxyvitamin D [25(OH)D] in CHF are not well understood, although an 
      association has been suggested between the deficiency and the advancement of CHF. 
      Also unknown is the influence of therapeutic escalation using recommended agents 
      on the serum level of 25(OH)D. The aim of this study was to examine the incidence 
      of abnormal 25(OH)D concentrations in CHF patients and to establish the clinical 
      and laboratory determinants of low activity of this metabolite. MATERIAL AND 
      METHODS: The retrospective analysis included the data of 412 CHF patients not 
      receiving optimal pharmacological treatment who were initially in NYHA (New York 
      Heart Association) class III or IV. Over the period of 3 months the therapy was 
      escalated until reaching maximum tolerated doses or those recommended by the 
      current guidelines. After optimizing the therapy, the incidence of 25(OH)D 
      deficiency (< 30 ng/ml) and insufficiency (< 20 ng/ml) was established, and 
      clinical and laboratory determinants for these abnormal concentrations were 
      analyzed. RESULTS: Normal serum level, insufficiency, and deficiency of 25(OH)D 
      were observed in, respectively, 41.5%, 26.0% and 32.5% of patients. The NYHA 
      class improved by at least 1 class in 63.6% of patients, remained unchanged in 
      32.8% of patients, and deteriorated in 3.6% of patients. In multivariables 
      analysis, low availability of natural ultraviolet B (UVB) radiation, loss of body 
      mass during the CHF, higher concentrations of phosphates and albumins, and the 
      presence of diabetes increased the risk of 25(OH)D deficiency, while higher 
      concentrations of uric acid reduced this risk. In patients with a positive 
      response to therapy, the concentration of 25(OH)D was borderline significantly 
      higher (p = 0.055), while insufficiency and deficiency were less frequent (p = 
      0.02) than in patients without a treatment response, but this pertained only to 
      patients with higher exposure to UVB. These differences were not observed in 
      patients with low UVB exposure. CONCLUSIONS: The concentration of 25(OH)D in CHF 
      patients is not associated with the advancement of the disease, but is strongly 
      determined by the potential availability of UVB radiation. A positive response to 
      therapy increases the concentration of 25(OH)D only in the case of high UVB 
      exposure; other determinants of 25(OH)D level include the patient's metabolic 
      profile and the presence of diabetes.
FAU - Myrda, Krzysztof
AU  - Myrda K
AD  - 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in 
      Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
FAU - Rozentryt, Piotr
AU  - Rozentryt P
AD  - 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in 
      Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
FAU - Niedziela, Jacek T
AU  - Niedziela JT
AD  - 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in 
      Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
FAU - Ociessa, Aneta
AU  - Ociessa A
AD  - 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in 
      Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
FAU - Kasperova, Maria
AU  - Kasperova M
AD  - 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in 
      Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
FAU - Hudzik, Bartosz
AU  - Hudzik B
AD  - 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in 
      Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
FAU - Nowak, Jolanta U
AU  - Nowak JU
AD  - 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in 
      Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
FAU - Gasior, Mariusz
AU  - Gasior M
AD  - 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in 
      Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
LA  - eng
PT  - Journal Article
DEP - 20150928
PL  - Poland
TA  - Kardiochir Torakochirurgia Pol
JT  - Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic 
      surgery
JID - 101279148
PMC - PMC4631913
OTO - NOTNLM
OT  - chronic heart failure
OT  - vitamin D deficiency
EDAT- 2015/12/25 06:00
MHDA- 2015/12/25 06:01
PMCR- 2015/09/01
CRDT- 2015/12/25 06:00
PHST- 2015/08/17 00:00 [received]
PHST- 2015/08/18 00:00 [revised]
PHST- 2015/09/03 00:00 [accepted]
PHST- 2015/12/25 06:00 [entrez]
PHST- 2015/12/25 06:00 [pubmed]
PHST- 2015/12/25 06:01 [medline]
PHST- 2015/09/01 00:00 [pmc-release]
AID - 25841 [pii]
AID - 10.5114/kitp.2015.54457 [doi]
PST - ppublish
SO  - Kardiochir Torakochirurgia Pol. 2015 Sep;12(3):216-27. doi: 
      10.5114/kitp.2015.54457. Epub 2015 Sep 28.