|PANDEY, AMBARISH - University Of Texas|
|KITZMAN, DALANE - Wake Forest University|
|HOUSTON, DENISE - Wake Forest University|
|CHEN, HAIYING - Wake Forest University|
|SHEA, KYLA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
Submitted to: American Journal of Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/20/2018
Publication Date: 12/1/2018
Citation: Pandey, A., Kitzman, D.W., Houston, D.K., Chen, H., Shea, K. 2018. Vitamin D status and exercise capacity in older patients with heart failure with preserved ejection fraction. American Journal of Medicine. 131(12):e11-1515.e19. https://doi.org/10.1016/j.amjmed.2018.07.009.
Interpretive Summary: Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure related to aging. Patients with HFpEF have difficulty walking or participating in other exercise activities, which impairs their quality of life. We evaluated the association between vitamin D status and exercise capacity in 112 HFpEF patients and 37 healthy age-matched controls because vitamin D appears to be involved in heart and skeletal muscle function. Over 91% of HFpEF patients were vitamin D insufficient, and nearly 30% were frankly deficient. HFpEF patients with lower vitamin D status had worse exercise capacity, whereas in the healthy controls vitamin D status was not associated with exercise capacity. These findings suggest improving vitamin D status could improve exercise capacity in HFpEF patients, but this needs to be tested in clinical trials.
Technical Abstract: Background: Older patients with heart failure with preserved ejection fraction (HFpEF) have severe exercise intolerance. Vitamin D may play a role in cardiovascular and skeletal muscle function, and may therefore be implicated in exercise intolerance in HFpEF. However, there are few data on vitamin D status and its relationship to exercise capacity in HFpEF patients. Methods: Plasma 25-hydroxyvitamin D [25(OH)D] and exercise capacity [peak oxygen consumption, (VO2), 6-minute walk distance (6MWD)] were measured in 112 older HFpEF patients (mean +/- SD age=70 +/- 8yrs) and 37 healthy age-matched controls (HC). General linear models were used to compare 25(OH)D between HFpEF patients and HCs and to determine the cross-sectional association between 25(OH)D and exercise capacity. The association between 25(OH)D and left ventricular (LV) function was evaluated secondarily in HFpEF patients. Results: 25(OH)D concentrations were significantly lower in HFpEF vs HCs (11.4 +/- 0.6ng/ml vs 19.1 +/- 2.1ng/ml; p=0.001, adjusted for age, race, gender, BMI, season). Over 90% of HFpEF patients had 25(OH)D insufficiency (<20ng/ml) and 30% had frank 25(OH)D deficiency (<10ng/ml). In HFpEF patients, but not HCs, 25(OH)D was significantly correlated with peak VO2 (r=0.26; p=0.007) and 6MWD (r=0.34; p<0.001). Conclusion: Over 90% of HFpEF patients had 25(OH)D insufficiency and 30% were frankly deficient. Lower 25(OH)D was associated with lower peak VO2 and 6MWD in HFpEF, suggesting 25(OH)D insufficiency could contribute to exercise intolerance in this patient population. These findings provide the data and rationale for a future randomized trial designed to test the potential for of vitamin D supplementation to improve exercise intolerance in HFpEF.