Effect of Vitamin D on Mortality in Heart Failure

Study Questions:

Does oral vitamin D supplementation reduce mortality in patients with advanced heart failure (HF)?

Methods:

The EVITA (Effect of Vitamin D on All-Cause Mortality in Heart Failure) trial was conducted to examine whether vitamin D supplementation is able to reduce mortality in patients with end-stage HF. The study cohort, comprised of 400 HF patients with circulating 25-hydroxyvitamin D (25OHD) levels <75 nmol/L, were randomized to receive 4000 IU vitamin D daily or matching placebo for 3 years. All-cause mortality was the primary endpoint. Secondary outcome measures included hospitalization, resuscitation, mechanical circulatory support (MCS) implant, high urgent listing for heart transplantation, heart transplantation, hypercalcemia, and circulating 25OHD levels >374 nmol/L.

Results:

The investigators found that initial 25OHD levels were on average <40 nmol/L, remained around 40 nmol/L in patients assigned to placebo, and plateaued around 100 nmol/L in patients assigned to vitamin D. Mortality was similar in patients receiving vitamin D (19.6%; n = 39) or placebo (17.9%; n = 36) with a hazard ratio (HR) of 1.09 (95% confidence interval [CI], 0.69-1.71; p = 0.726). The need for MCS implant was, however, greater in patients assigned to vitamin D (15.4%, n = 28) versus placebo (9.0%, n = 15; HR, 1.96; 95% CI, 1.04-3.66; p = 0.031). Hospitalization rate was 67.4% (n = 126) and 60.0% (n = 112) in patients assigned to vitamin D and placebo, respectively (p = 0.075). The incidence of high urgent listing for heart transplantation, heart transplantation, and resuscitation were similar between groups as well. Other secondary clinical endpoints were similar between groups. The incidence of hypercalcemia was 6.2% (n = 10) and 3.1% (n = 5) in patients receiving vitamin D or placebo (p = 0.192).

Conclusions:

The authors concluded that vitamin D replacement did not reduce mortality in HF, but was associated with more MCS implants.

Perspective:

It is unclear whether the association of vitamin D replacement and more MCS implants is merely a reflection of natural history of disease progression or whether vitamin D accelerates disease progression. The findings of this study suggest that until more evidence is available, vitamin D replacement in advanced HF should be done judiciously.

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant

Keywords: Disease Progression, Geriatrics, Heart Failure, Heart Transplantation, Hypercalcemia, Mortality, Outcome Assessment (Health Care), Resuscitation, Vitamin D


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