Vitamin D benefits only elderly patients with heart failure: EVITA trial

According to a new study, Vitamin D supplementation benefits only elderly patients with heart failure. It may not improve cardiac function in all patients with heart failure, but probably in patients aged ≥ 50 years. The study has been published in the International Journal of Cardiology.

The researchers investigated the effect of a daily vitamin D₃ supplement of 4,000 IU for three years on cardiac function. The study was conducted because the effect of vitamin D on cardiac function is hotly debated but available data are inconclusive. Moreover, data regarding the effects of vitamin D on cardiac function are inconclusive. Despite significant therapeutic improvements, congestive heart failure (CHF) patients still have a poor prognosis. Currently, 5-year survival rates are only 35-50%. There is an accumulating body of evidence from prospective cohort studies that low circulating 25-hydroxyvitamin D is an independent predictor of all-cause and cardiovascular mortality, respectively. Vitamin D deficiency is prevalent among CHF patients.

In a post-hoc analysis of the EVITA (Effect of vitamin D on mortality in heart failure) trial, Dr A. Zittermann and colleagues investigated whether a daily vitamin D₃ supplement of 4000 IU for three years affects echocardiography parameters like left ventricular end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), and LV ejection fraction (LVEF) in patients with advanced heart failure (HF) and 25‑hydroxyvitamin D levels <75 nmol/L.

In a total of 400 patients enrolled, 199 were assigned to vitamin D and 201 to placebo. The investigators assessed time × treatment interaction effects using linear mixed models and analyzed in subgroups vitamin D effects at 12 and 36 months post-randomization using analysis of covariance with adjustments for baseline values.

It was found that at baseline, values of LVEDD, LVESD, and LVEF were 67.5 ± 10.5 mm, 58.9 ± 12.0 mm, and 30.47 ± 10.2%, respectively. There were no time × treatment interaction effects on LV echocardiographic parameters in the entire study cohort, neither at 12 months nor at 36 months post-randomization. However, in the subgroup of patients aged ≥50 years, vitamin D treatment was associated with an increase in LVEF of 2.73% at 12 months post-randomization. The increase was slightly attenuated to 2.60% at 36 months post-randomization .

The researchers concluded that the data indicates that vitamin D supplementation does not significantly improve cardiac function in all patients with advanced HF. However, vitamin D probably improves LV function in HF patients aged ≥50 years.

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