Risk of Heart Failure Among Postmenopausal Women: A Secondary Analysis of the Randomized Trial of Vitamin D Plus Calcium of the Women's Health Initiative | Journal Scan

Study Questions:

Does vitamin D supplementation reduce the risk for heart failure among postmenopausal women?

Methods:

Data from the Women’s Health Initiative randomized trial of calcium and vitamin D (CaD) supplementation were used for the present analysis. Women ages 50-79 years were randomized in a 1:1 double-blinded protocol to 1000 mg/day of calcium with 400 IU/day of vitamin D3 or placebo. Heart failure was defined as self-reported hospitalization for heart failure and confirmed by medical record abstraction and review.

Results:

A total of 35,983 women were included in this analysis. During a median follow-up of 7.1 years, 744 adjudicated cases of heart failure were identified (3,381 cases from the control group and 363 from the group receiving CaD supplementation). Supplementation was not associated with reduced risk for heart failure (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.82-1.09). When the cohort was examined by factors associated with risk for heart failure (including coronary heart disease, diabetes, or hypertension), risk associated with CaD differed among high-risk women compared to low-risk women. Among women with a low risk for heart failure (n = 18,534), supplementation was associated with a reduced risk for heart failure (HR, 0.63; 95% CI, 0.46-0.87), which was not observed among high-risk women (HR, 1.06; 95% CI, 0.90-1.24).

Conclusions:

The authors concluded that CaD supplementation was not significantly associated with reduced heart failure incidence in the total cohort. However, it appeared to reduce incident heart failure among women without major heart failure risk factors (i.e., those at low risk).

Perspective:

As the authors suggest, additional research is required prior to clinical recommendations for vitamin D supplementation to reduce risk for heart failure. Management of known factors associated with increased risk, such as blood pressure management, continues to be important particularly among postmenopausal women at increased risk for heart failure.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Acute Heart Failure, Diet, Hypertension

Keywords: Blood Pressure, Cholecalciferol, Diabetes Mellitus, Dietary Supplements, Heart Failure, Hospitalization, Hypertension, Medical Records, Risk Factors, Women's Health, Calcium, Dietary


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