Advances in Clinical and Experimental Medicine
2016, vol. 25, nr 1, January-February, p. 51–57
Publication type: original article
Low-Level Vitamin D Is Associated with Atrial Fibrillation in Patients with Chronic Heart Failure
1 Department of Cardiology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
2 Department of Cardiology, Ahi Evren Heart and Vascular Surgery Training and Research Hospital, Trabzon, Turkey
3 Department of Cardiology, Kahramanmaras Necip Fazıl State Hospital, Kahramanmaras, Turkey
Background. Atrial fibrillation (AF) frequently accompanies heart failure (HF), and causes exacerbation of symptoms and treatment failure in such patients. Vitamin D was recently suggested to be an important mediator of cardiovascular disease, including HF.
Objectives. The aim of this study was to evaluate the relationship between vitamin D deficiency and AF in patients with chronic HF.
Material and Methods. The study included 180 chronic HF patients that were divided into 2 groups based on having sinus rhythm [AF (–) group] or chronic AF [AF (+) group]. Vitamin D status was assessed via measurement of the serum 25-hydroxyvitamin D (25[OH]D) concentration.
Results. Mean age of the patients was 66 ± 8.7 years and 53.9% were male. There weren’t any significant differences in age, gender, body mass index, etiology or chronic HF stage between the 2 groups. The vitamin D level in the AF (+) group was significantly lower than in the AF (–) group (11.05 ng/mL vs. 20 ng/mL, p < 0.001) and the parathyroid hormone level was significantly higher in the AF (+) group (76.7 vs. 55 pq mL, p < 0.001). The left atrium to body surface area ratio (LA/BSA) was significantly higher in the AF (+) group (45.03 mm/m2 vs. 42.05 mm/m2, p < 0.01). Independent predictors (based on multiple regression) of AF were vitamin D level (OR = 0.854, 95% CI: 0.805–0.907, p < 0.001) and LA/BSA ratio (OR = 1.077, 95% CI: 1.003–1.156, p < 0.05). The optimal vitamin D cut-off value for the prediction of AF was 16.50 ng/mL, with a sensitivity of 76.0% and specificity of 65.5% (AUC = 0.75, 95% CI: 0.67–0.82).
Conclusion. A low plasma vitamin D concentration was strongly associated with AF in patients with chronic HF.
heart failure, atrial fibrillation, vitamin D
- Murakoshi N, Aonuma K: Epidemiology of arrhythmias and sudden cardiac death in Asia. Circ J 2013, 77, 2419– –2431.
- Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, Seward JB, Tsang TS: Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006, 114, 119–125.
- Linhartová K, Veselka J, Sterbáková G, Racek J, Topolcan O, Cerbák R: Parathyroid hormone and vitamin D levels are independently associated with calcific aortic stenosis. Circ J 2008, 72, 245–250.
- Walters MR, Wicker DC, Riggle PC: 1,25-Dihydroxyvitamin D3 receptors identified in the rat heart. J Mol Cell Cardiol 1986, 18, 67–72.
- Somjen D, Weisman Y, Kohen F, Gayer B, Limor R, Sharon O, Jaccard N, Knoll E, Stern N: 25-hydroxyvitamin D3-1alpha-hydroxylase is expressed in human vascular smooth muscle cells and is upregulated by parathyroid hormone and estrogenic compounds. Circulation 2005, 111, 1666–16671.
- Wong MS, Delansorne R, Man RY, Vanhoutte PM: Vitamin D derivatives acutely reduce endothelium-dependent contractions in the aorta of the spontaneously hypertensive rat. Am J Physiol Heart Circ Physiol 2008, 295, 289–296.
- Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP: 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin–angiotensin system. J Clin Invest 2002, 110, 229–238.
- Van Etten E, Mathieu C: Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol 2005, 97, 93–101.
- Resnick LM, Müller FB, Laragh JH: Calcium-regulating hormones in essential hypertension. Relation to plasma renin activity and sodium metabolism. Ann Intern Med 1986, 105, 649–654.
- Kong J, Kim GH, Wei M, Sun T, Li G, Liu SQ, Li X, Bhan I, Zhao Q, Thadhani R, Li YC: Therapeutic effects of vitamin D analogs on cardiac hypertrophy in spontaneously hypertensive rats. Am J Pathol 2010, 177, 622–631.
- Lindqvist PG, Epstein E, Olsson H: Does an active sun exposure habit lower the risk of venous trombotic events? A D-lightful hypothesis. J Thrombosis Haemostasis 2009, 7, 605–610.
- Hagiwara N: Inflammation and atrial fibrillation. Circ J 2010, 74, 246–247.
- Kimura M, Ogawa H, Wakeyama T, Takaki A, Iwami T, Hadano Y, Mochizuki M, Hiratsuka A, Shimizu A, Matsuzaki M: Effects of mineralocorticoid receptor antagonist spironolactone on atrial conduction and remodeling in patients with heart failure. J Cardiol 2011, 57, 208–214.
- Zittermann A, Schleithoff SS, Tenderich G, Berthold HK, Körfer R, Stehle P: Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 2003, 41, 105–112.
- Qayyum F, Landex NL, Agner BR, Rasmussen M, Jøns C, Dixen U: Vitamin D deficiency is unrelated to type of atrial fibrillation and its complications. Dan Med J 2012, 59, A4505.
- Chen WR, Liu ZY, Shi Y, Yin da W, Wang H, Sha Y, Chen YD: Relation of low vitamin D to nonvalvular persistent atrial fibrillation in Chinese patients. Ann Noninvasive Electrocardiol 2014, 19, 166–173.
- Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B: ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on
- Milovanovic M, Pesic G, Nikolic V, Jevtovic-Stoimenov T, Vasic K, Jovic Z, Deljanin-Ilic M, Pesic S: Vitamin D deficiency is associated with increased IL-17 and TNFα levels in patients with chronic heart failure. Arq Bras Cardiol 2012, 98, 259–265.
- Hanafy DA, Chang SL, Lu YY, Chen YC, Kao YH, Huang JH, Chen SA, Chen YJ: Electromechanical effects of 1,25-dihydroxy vitamin D with antiatrial fibrillation activities. J Cardiovasc Electrophysiol 2014, 25, 317–323.
- Forman JP, Williams JS, Fisher ND: Plasma 25-hydroxyvitamin D and regulation of the renin-angiotensin system in humans. Hypertension 2010, 55, 1283–1288.
- Park CW, Oh YS, Shin YS, Kim CM, Kim YS, Kim SY, Choi EJ, Chang YS, Bang BK: Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis 1999, 33, 73–81.
- Rienstra M, Cheng S, Larson MG, McCabe EL, Booth SL, Jacques PF, Lubitz SA, Yin X, Levy D, Magnani JW, Ellinor PT, Benjamin EJ, Wang TJ: Vitamin D status is not related to development of atrial fibrillation in the community. Am Heart J 2011, 162, 538–541.
- Demir M, Uyan U, Melek M: The effects of vitamin D deficiency on atrial fibrillation. Clin Appl Thromb Hemost 2014, 20, 98–103.
- Rahman A, Hershey S, Ahmed S, Nibbelink K, Simpson RU: Heart extracellular matrix gene expression profile in the vitamin D receptor knockout mice. J Steroid Biochem Mol Biol 2007, 103, 416–419.
- Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R. Vitamin D Supplementation Improves Cytokine Profile In Patients With Congestive Heart Failure: A Double-Blind, Randomized, Placebo-Controlled Trial. Am J Clin Nutr 2006, 83, 754–759.
- Muller K, Haahr PM, Diamant M, Rieneck K, Kharazmi A, Bendtzen K: 1,25-Dihydroxyvitamin D3 inhibits cytokine production by human blood monocytes at the post-transcriptional level. Cytokine 1992, 4, 506–512.
- Ichiki H, Orihara K, Hamasaki S, Ishida S, Oketani N, Iriki Y, Ninomiya Y, Okui H, Kuwahata S, Fujita S, Matsushita T, Yoshifuku S, Oba R, Hirai H, Nagata K, Tei C: The role of infection in the development of nonvalvular atrial fibrillation: up-regulation of Toll-like receptor 2 expression levels on monocytes. J Cardiol 2009, 53, 127–135.
- Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA, Bauer JA, Tchou PJ, Niebauer MJ, Natale A, Van Wagoner DR: C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2001, 104, 2886–2891.
- Anand IS, Latini R, Florea VG, Kuskowski MA, Rector T, Masson S, Signorini S, Mocarelli P, Hester A, Glazer R, Cohn JN: Val-HeFT Investigators. C-reactive protein in heart failure: prognostic value and the effect of valsartan. Circulation 2005, 112, 1428–1434.
- Rienstra M, Lubitz SA, Zhang ML, Cooper RR, Ellinor PT: Elevation of parathyroid hormone levels in atrial fibrillation. J Am Coll Cardiol 2011, 57, 2542–2543.