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This version published online on August 5, 2008
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2008-0784
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*Compound via MeSH
*Substance via MeSH
Medline Plus Health Information
*Cardiac Arrest
*Heart Failure

Submitted on April 10, 2008
Accepted on July 21, 2008

Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography

Stefan Pilz MD*, Winfried März MD, Britta Wellnitz LLD, Ursula Seelhorst MA, Astrid Fahrleitner-Pammer MD, Hans P. Dimai MD, Bernhard O. Boehm MD, and Harald Dobnig MD*

Department of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany (Pilz, März); Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Medical University of Graz, Austria (Pilz, Fahrleitner-Pammer, Dimai, Dobnig); Synlab Center of Laboratory Diagnostics, Heidelberg, Germany (März); LURIC Study nonprofit LLC, Freiburg, Germany (Wellnitz, Seelhorst); Department of Internal Medicine I, Division of Endocrinology and Diabetes, Ulm University, Germany (Boehm)

* To whom correspondence should be addressed. E-mail: stefan.pilz{at}chello.at or harald.dobnig{at}meduni-graz.at.

Context: Vitamin D has been shown to influence cardiac contractility and myocardial calcium homeostasis.

Objectives: We aimed to elucidate whether insufficient vitamin D status is associated with heart failure and sudden cardiac death (SCD).

Design, Setting and Participants: We measured 25-hydroxyvitamin D [25(OH)D] levels in 3299 Caucasian patients who were routinely referred to coronary angiography at baseline (1997–2000).

Main outcome measures: Cross-sectional associations of 25(OH)D levels with measures of heart failure and Cox proportional hazard ratios for deaths due to heart failure and for SCD according to vitamin D status.

Results: 25(OH)D was negatively correlated with N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), and was inversely associated with higher NYHA classes and impaired left ventricular function. During a median follow-up time of 7.7 years, 116 patients died due to heart failure and 188 due to SCD. After adjustment for cardiovascular risk factors, the hazard ratios (with 95% confidence intervals) for death due to heart failure and for SCD were 2.84 (1.20–6.74) and 5.05 (2.13–11.97), respectively, when comparing patients with severe vitamin D deficiency [25(OH)D < 25 nmol/L)] with persons in the optimal range [25(OH)D ≥ 75 nmol/L]. In all statistical analyses we obtained similar results with 25(OH)D and with 1,25-dihydroxyvitamin D [1,25(OH)2D].

Conclusions: Low levels of 25(OH)D and 1,25(OH)2D are associated with prevalent myocardial dysfunction, deaths due to heart failure and SCD. Interventional trials are warranted to elucidate whether vitamin D supplementation is useful for treatment and/or prevention of myocardial diseases.
Key words: Vitamin D • cardiovascular disease • heart failure • sudden cardiac death • mortality




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