Heart Failure, Risk Increases in Elderly with Vitamin D Deficiency

The risk of heart failure is 12 times higher in elderly individuals with vitamin D deficiency compared to those with adequate levels. Indeed, low vitamin D levels represent a risk factor for heart failure greater than obesity or arrhythmia. Therefore, vitamin D supplementation could potentially become an effective and economical strategy for preventing certain cardiac disorders in the future.

This was discovered by researchers at the University of Pernambuco, Recife, Brazil. The research results were published in the specialized journal ESC Heart Failure.

Heart failure is a widespread problem in the elderly

Heart failure, or cardiac insufficiency, is a condition in which the heart is unable to pump a sufficient amount of blood to all tissues and organs of the body due to weakening of the myocardial tissue. The consequences and symptoms of this condition vary and include shortness of breath during physical exertion, breathing difficulties when lying down, cough, swollen abdomen, and confusion. Heart failure is very common and represents an important public health issue, being one of the main causes of hospitalization among the elderly. As age progresses, the myocardium undergoes changes in its composition and therefore function. Risk factors associated with heart failure include:

• advanced age
• male gender
• diabetes mellitus
• acute myocardial infarction
• hypertension

There is strong evidence in the scientific literature regarding the association between vitamin D deficiency and the risk of heart failure, as well as vitamin D’s role in cardiocirculatory metabolism. For example, the prospective “LURIC” study, conducted on 3,299 patients with cardiovascular disease, found a high prevalence of myocardial dysfunction associated with severe vitamin D deficiency.

A recent study by researchers at the Teaching Hospitals of Leeds on 163 patients with heart failure demonstrated that vitamin D supplements can improve the heart’s ability to pump blood throughout the body. As is known, besides obtaining vitamin D from certain foods, the human body can produce it through a series of reactions initiated by sunlight exposure on the skin. Therefore, in some countries, especially during winter months, vitamin D deficiency is more frequent. This condition is very common among those over sixty.

Older individuals often follow poor diets, typically have impaired intestinal function, and limited exposure to daylight. For these reasons, they frequently do not reach the minimum recommended level (30 ng/mL) of 25-hydroxyvitamin D, the inactive form of vitamin D measured in the blood.

Heart failure: more likely when vitamin D is deficient  

According to the new study, which correlated heart failure in elderly Brazilians with various risk factors, the likelihood of cardiac insufficiency affects more than half of the selected elderly and is strongly associated with vitamin D deficiency. Specifically, results revealed that the risk of heart failure was 12 times higher in elderly individuals with low blood vitamin D levels compared to those with adequate status, and this factor increased the likelihood of cardiac disorder more than obesity or arrhythmia. However, the researchers conducting the study stated that further studies are needed to test the potential role of vitamin D supplements for preventing heart diseases in the elderly. In any case, based on the evidence obtained and supported by numerous other studies, the high percentage of elderly individuals with decreased vitamin D and its consequences on the risk of heart failure suggest the need to establish recommendations on vitamin dosage necessary to maintain heart health.

Study details 

Between August 2015 and February 2016, researchers collected clinical data from 137 elderly Brazilian patients undergoing routine cardiological evaluations. The adequacy threshold for vitamin D, measured as 25-hydroxyvitamin D, was established in this study as below 30 nanograms per milliliter of blood. To analyze the association between vitamin deficiency and the risk of heart failure, researchers used specific statistical analyses.

Data collection showed that most elderly involved were overweight or obese, with a high waist-hip ratio, and with a high prevalence of dyslipidemia and hypertension. Moreover, 91.2% of subjects were hypertensive, 35% had coronary disease, and 27.7% had cardiac arrhythmia. A striking 62% of subjects in the study showed 25-hydroxyvitamin D deficiency and among these, 78.7% presented an increased risk of heart failure.

Statistical analysis results showed that among those deficient in vitamin D, the likelihood of heart failure was 12.2 times higher compared to those with normal vitamin levels. Men were found to be more predisposed to heart failure, and the risk was associated, albeit to a lesser extent than vitamin D deficiency, also with obesity and arrhythmia.

Vitamin D supplementation? Effects will be confirmed by further research.

Thanks to the results obtained, scientists found a high percentage of elderly with 25-hydroxyvitamin D deficiency, and a strong association between this nutritional deficit and increased risk of heart failure. The researchers could not determine whether vitamin D deficiency is the true cause of the pathology or not. However, they suggested that a lower risk of heart failure could derive from the vitamin’s ability to suppress the inflammatory response, an important factor in the pathogenesis of heart failure. For these reasons, and considering the low cost of potential supplementation, the scientists conducting the study hypothesized the possibility of preventing and treating some cardiac dysfunctions with vitamin D supplements, if future studies confirm their efficacy.

Source: Magalhães Porto et al., “Association between vitamin D deficiency and heart failure risk in the elderly”. ESC Heart Failure 2018 Feb; 5(1): 63–74.