Our office sees many patients with a long history of cardiovascular care. This care for the most part centers around the use of blood pressure medications, cholesterol medications, and blood thinners in varying dosage and combinations. Many people can manage their heart conditions successfully with these treatments. Some people, like those who visit our office are looking for other methods that may offer them more vitality, energy, and less side effects. This article will focus on the role of vitamin D deficiency in patients with worsening heart failure and how supplementation of vitamin D may support heart health in some patients.
Lipid Metabolism and atherosclerosis
A February 2021 (1) study suggests that vitamin D supplementation influences the levels of serum lipids in that it lowers the levels of total cholesterol, triglycerides, and LDL-cholesterol and increases the levels of HDL-cholesterol
Vitamin D is also involved in the development of atherosclerosis at the site of the blood vessels. Deficiency of this vitamin has been found to increase adhesion molecules or endothelial activation and, at the same time, supplementation is linked to the lowering presence of adhesion surrogates. (Cell adhesion molecules are involved in plaque progression, myocardial infarction.)
Vitamin D can also influence the vascular tone by increasing endothelial nitric oxide production, as seen in supplementation studies. nitric oxide is a neurotransmitter that helps improve blood circulation by relaxing blood vessels and keeping them elastic.
Deficiency can lead, at the same time, to oxidative stress and an increase in inflammation as well as the expression of particular immune cells that play a pivotal role in the development of atherosclerosis in the blood vessels
Furthermore, vitamin D deficiency is consistently associated with cardiovascular events, such as myocardial infarction, ST-Elevation Myocardial Infarction, Non-ST-elevation myocardial infarction, unstable angina, ischemic stroke, cardiovascular death, and increased mortality after acute stroke. Conversely, vitamin D supplementation does not seem to produce beneficial effects in cohorts with intermediate baseline vitamin D levels.
Fatigue, weakness, difficulty breathing, shortness of breath, swelling, and water retention
Many of our patients who have heart issues have problems of heart failure with “preserved ejection fraction” or “diastolic heart failure.” Many studies are now examining the role of vitamin D supplementation in managing this problem. To understand these studies and the possible benefits of vitamin D in heart health that they discuss, let’s start our understanding of “heart failure with “preserved ejection fraction.”
A recent study (2) in the medical journal American family physician gives an excellent outline of the problem of heart failure with preserved ejection fraction.
“Heart failure with preserved ejection fraction, also referred to as diastolic heart failure, causes almost one-half of the 5 million cases of heart failure in the United States. It is more common among older patients and women, and results from abnormalities of active ventricular relaxation and passive ventricular compliance refill (this is a functioning problem of your heart relaxing and refilling with blood ready to be pumped out again) refill, leading to a decline in stroke volume and cardiac output. (Your heart is not pumping sufficient blood).
Heart failure with preserved ejection fraction should be suspected in patients with typical symptoms (e.g., fatigue, weakness, dyspnea (difficulty breathing), orthopnea (shortness of breath), paroxysmal nocturnal dyspnea (shortness of breath or coughing at night), edema (swelling, water retention).
Multiple trials have not found medications to be an effective treatment, except for diuretics. Patients with congestive symptoms should be treated with a diuretic. If hypertension is present, it should be treated according to evidence-based guidelines. Exercise and treatment by multidisciplinary teams may be helpful. Atrial fibrillation should be treated using a rate-control strategy and appropriate anticoagulation. Revascularization (Coronary bypass) should be considered for patients with heart failure with preserved ejection fraction and coronary artery disease.”
So in brief, patients with this condition are suggested to diuretics and bypass surgery.
An exploration of low levels of Vitamin D
Some researchers are looking for more answers and more options beyond bypass and diuretics. A recent 2019 study in the European journal of heart failure, (3) offered this evidence for a supportive role of vitamin D. Here is the summary of their research:
“Vitamin D deficiency is prevalent in heart failure, but its relevance in early stages of heart failure with preserved ejection fraction is unknown. We tested the association of 25-hydroxyvitamin D [25(OH)D] serum levels with mortality, hospitalizations, cardiovascular risk factors, and echocardiographic parameters in patients with asymptomatic diastolic dysfunction or newly diagnosed heart failure with preserved ejection fraction.
Participants were examined and grouped based on outcome of physical examination, echocardiography, and 6 min walk test. These patients were then studied in 5 year followup ups.
Results of findings:
Lower (Vitamin D) levels were associated with reduced functional capacity in patients with diastolic dysfunction or heart failure with preserved ejection fraction and were significantly predictive for an increased rate of cardiovascular hospitalizations.
These findings were supported by a February 2020 study (4) published by the University of Miami Miller School of Medicine. In this research doctors questioned “Is vitamin D deficiency related to a higher risk of hospitalization and mortality in veterans with heart failure?” Here is what they wrote:
“25-hydroxyvitamin D [25(OH)D] deficiency is related to an increase in cardiovascular risk but the association between low 25(OH)D and hospitalization and mortality in heart failure patients remains unclear. The objective of this study was therefore to determine whether 25(OH)D deficiency is associated with a higher risk of all-cause hospitalizations and mortality in veterans with heart failure, as well as the differential effect of frailty.”
Brief note: Vitamin D deficiency has been seen as a factor in progressing heart disease, but to what effect is somewhat controversial.
The researchers in this study then identified 284 patients, of whom 141 (50 %) exhibited 25(OH)D deficiency (average age 67).
Over an average follow-up of 1136 days (A little more than three years) there were:
617 hospitalizations (68 % in those with 25(OH)D deficiency) and 131 deaths (40 % in those with 25(OH)D deficiency).
A significantly higher risk of hospitalization was found in patients with 25(OH)D deficiency:
Frail veterans had a greater risk of hospitalization than non-frail veterans:
The conclusion of this research?
25(OH)D deficiency was an independent risk factor for hospitalization in patients with heart failure and the effect persisted in those with frailty.
The role of vitamin D in heart health
So people with vitamin D deficiency have independent risk factors for heart failure. Can restoring levels be beneficial? A December 2019 (5) study presents this evidence.
“Vitamin D plays a pivotal role in bone homeostasis and calcium metabolism. However, recent research has indicated additional beneficial effects of vitamin D on the cardiovascular system. This review aims to elucidate if vitamin D can be used as an add-on treatment in coronary artery disease.
Large-scale epidemiological studies have found a significant inverse association between serum 25(OH)-vitamin D levels and the prevalence of essential hypertension.
Likewise, epidemiological data have suggested plasma levels of vitamin D to be inversely correlated to cardiac injury after acute myocardial infarction (MI).
Remarkably, in vitro trials have showed that vitamin D can actively suppress the intracellular NF-κB pathway (the production of inflammation) to decrease coronary artery disease progression. This is suggested as a mechanistic link to explain how vitamin D may decrease vascular inflammation and atherosclerosis.
A review of randomized controlled trials with vitamin D supplementation showed ambiguous results. This may partly be explained by heterogeneous study groups. It is suggested that subgroups of diabetic patients may benefit more from vitamin D supplementation. Moreover, some studies have indicated that calcitriol (synthetic vitamin D) rather than cholecalciferol (vitamin D) exerts more potent beneficial effects on atherosclerosis and coronary artery disease. Therefore, further studies are required to clarify these assumptions.
These studies represent only the tip of the iceberg when it comes to vitamin D and heart health, but the represent some of the latest findings. The question you have is probably then, “Can vitamin D help me?”
At the Magaziner Center for Wellness we use a functional medicine approach to treat heart disease utilizing natural therapies that work in conjunction with the body by facilitating, enabling and assisting its normal healing processes. We analyze your results from a series of extremely thorough tests and develop an individualized treatment plan based on lifestyle, stressors, environment, diet, health history and the levels of various nutrients and toxins, including heavy metals, present in the body. We make use of chelation therapy, various nutraceuticals to improve heart function, an anti-inflammatory based-diet and lifestyle changes, stress-reduction techniques and controlled exercise, with the objective of restoring the cardiac function to as normal a state as possible. Vitamin D maybe part of that strategy.
If you would like to explore more options to the treatments you have been given that are not working for you, please contact our office so we can start a conversation with you.
1 Surdu AM, Pînzariu O, Ciobanu DM, Negru AG, Căinap SS, Lazea C, Iacob D, Săraci G, Tirinescu D, Borda IM, Cismaru G. Vitamin D and Its Role in the Lipid Metabolism and the Development of Atherosclerosis. Biomedicines. 2021 Feb;9(2):172.
2 Gazewood JD, Turner PL. Heart failure with preserved ejection fraction: diagnosis and management. American family physician. 2017 Nov 1;96(9):582-8.
3 Nolte K, Herrmann-Lingen C, Platschek L, Holzendorf V, Pilz S, Tomaschitz A, Düngen HD, Angermann CE, Hasenfuß G, Pieske B, Wachter R, Edelmann F. Vitamin D deficiency in patients with diastolic dysfunction or heart failure with preserved ejection fraction. ESC Heart Fail. 2019 Apr;6(2):262-270. doi: 10.1002/ehf2.12413. Epub 2019 Feb 19. PMID: 30784226; PMCID: PMC6437442.
4 Aparicio-Ugarriza R, Salguero D, Mohammed YN, Ferri-Guerra J, Baskaran DJ, Mirabbasi SA, Rodriguez A, Ruiz JG. Is vitamin D deficiency related to a higher risk of hospitalization and mortality in veterans with heart failure?. Maturitas. 2020 Feb 1;132:30-4.
5 Legarth C, Grimm D, Krüger M, Infanger M, Wehland M. Potential Beneficial Effects of Vitamin D in Coronary Artery Disease. Nutrients. 2020 Jan;12(1):99.