Abstract 13643: A Randomized Controlled Trial of Vitamin D3 Lowers Aldosterone in Patients with Heart Failure

Abstract

Background: Vitamin D deficiency is associated with a risk of cardiac events including HF. Studies of animal models indicate that vitamin D down-regulates RAS. There is a scarcity of data regarding the effect of vitamin D repletion in patients with HF. Therefore we conducted a RCT of vitamin D3 therapy in order to test the hypothesis that vitamin D3 would decrease RAS, reduce inflammation and improve cardiac function in patients with HF.

Methods: Patients with NYHA II-IV HF (irrespective of EF) and a 25OHD level ≤ 37.5 ng/mL received weekly vitamin D3 50,000 IU (n=31) or placebo (n=33) for 6 months; all received daily calcium 800 mg. Serum aldosterone, renin, hsCRP, 2D echocardiogram and Doppler echocardiography were collected at baseline and 6 months. Between group comparisons were made with ANCOVA models that adjusted for baseline measures.

Results: Mean age of participants 65.9 ± 10.4 years old, women 48%, AA 64%, mean EF 37.6 ± 13.9, NYHA class III 36 %, II 64%, ischemic 28% and hypertensive 84%. Ninety-two percent were on an ACE-I or ARB and 88% on a beta blocker. There was no difference between use or dosing of ACE-I, ARBs, or beta blockers between groups. Comparison of the vitamin D group to placebo showed a significant decrease in 25OHD, PTH and aldosterone from baseline to 6 months (Table). There was no difference in change from baseline to 6 months between groups in renin, hsCRP or echocardiographic measures of systolic and diastolic function and LV mass. Adjustment for baseline characteristics sex, race, and ejection fraction did not change results.

Conclusions: Vitamin D3 decreases aldosterone through a non-renin dependent mechanism. Vitamin D may be an important adjunct to standard HF therapy. Further study is warranted to assess if vitamin D provides long term benefit to patients with HF.