Effects of Vitamin D Supplementation on Renin and Aldosterone Concentrations in Patients with Advanced Heart Failure: The EVITA Trial
Objective. 1,25-Dihydroxyvitamin D (1,25([OH]2D) is considered to be a negative endogenous regulator of the renin-angiotensin-aldosterone system (RAAS), but the effect of vitamin D supplementation on the RAAS is inconclusive. Design. In this prespecified secondary analysis of a randomized controlled...
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Wiley
2018-01-01
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| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2018/5015417 |
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| author | Armin Zittermann Jana B. Ernst Sylvana Prokop Uwe Fuchs Jens Dreier Joachim Kuhn Cornelius Knabbe Jochen Börgermann Heiner K. Berthold Stefan Pilz Ioanna Gouni-Berthold Jan F. Gummert |
| author_facet | Armin Zittermann Jana B. Ernst Sylvana Prokop Uwe Fuchs Jens Dreier Joachim Kuhn Cornelius Knabbe Jochen Börgermann Heiner K. Berthold Stefan Pilz Ioanna Gouni-Berthold Jan F. Gummert |
| author_sort | Armin Zittermann |
| collection | DOAJ |
| description | Objective. 1,25-Dihydroxyvitamin D (1,25([OH]2D) is considered to be a negative endogenous regulator of the renin-angiotensin-aldosterone system (RAAS), but the effect of vitamin D supplementation on the RAAS is inconclusive. Design. In this prespecified secondary analysis of a randomized controlled trial, we assessed in 165 patients with heart failure (vitamin D group: n=83; placebo group: n=82) the effect of three years of vitamin D supplementation with 4000 IU daily on parameters of the RAAS (renin and aldosterone) and on circulating 1,25(OH)2D, plasma phosphate, and fibroblast growth factor (FGF)-23. We assessed age- and baseline-adjusted between-group differences at study termination. Results. Almost all patients were under treatment with beta-blockers, inhibitors of the RAAS, and diuretics. Initially, the frequency of concentrations above the laboratory-specific reference range (renin: >23.9 mIU/L; aldosterone: >232 ng/L) in the vitamin D and placebo group was 87.7% and 92.7%, respectively (renin), and 24.1% and 32.5%, respectively (aldosterone). Vitamin D increased adjusted 1,25(OH)2D concentrations significantly (mean treatment effect and 95% CI: 18.3 pmol/L,7.3 to 29.3 pmol/L; P<0.001) but had no significant effects on phosphate (0.18 mmol/L, −0.00 to 0.35 mmol/L; P=0.051), FGF-23 (685 RU/mL, −213 to 1585 RU/mL; P=0.134), renin (312 mIU/L, −279 to 902 ng/L; P=0.298), or aldosterone (−0.19 ng/L, −5.09 to 4.70 ng/L; P=0.938). Vitamin D supplementation was, however, associated with an increase in renin concentrations in the subgroup with baseline 25-hydroxyvitamin D below 30 nmol/L (n=67; 1365 mIU/, 343 to 2386 mIU/L; P=0.010). Conclusions. In patients with advanced heart failure treated according to evidence-based guidelines, vitamin D supplementation did not significantly influence parameters of the RAAS in the entire study cohort but was associated with an increase in plasma renin concentrations in the subgroup with low baseline 25-hydroxyvitamin D concentrations. |
| format | Article |
| id | doaj-art-f75d4f77b48a4dd7be83d3a01d200ae6 |
| institution | OA Journals |
| issn | 1687-8337 1687-8345 |
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| publishDate | 2018-01-01 |
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| series | International Journal of Endocrinology |
| spelling | doaj-art-f75d4f77b48a4dd7be83d3a01d200ae62025-08-20T02:22:46ZengWileyInternational Journal of Endocrinology1687-83371687-83452018-01-01201810.1155/2018/50154175015417Effects of Vitamin D Supplementation on Renin and Aldosterone Concentrations in Patients with Advanced Heart Failure: The EVITA TrialArmin Zittermann0Jana B. Ernst1Sylvana Prokop2Uwe Fuchs3Jens Dreier4Joachim Kuhn5Cornelius Knabbe6Jochen Börgermann7Heiner K. Berthold8Stefan Pilz9Ioanna Gouni-Berthold10Jan F. Gummert11Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyClinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyClinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyClinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyInstitute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyInstitute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyInstitute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyClinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyDepartment of Internal Medicine and Geriatrics, Bethel Clinic (EvKB), 33611 Bielefeld, GermanyPolyclinic for Endocrinology, Diabetes and Preventive Medicine (PEDP), University of Cologne, 50937 Cologne, GermanyDivision of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, AustriaClinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, GermanyObjective. 1,25-Dihydroxyvitamin D (1,25([OH]2D) is considered to be a negative endogenous regulator of the renin-angiotensin-aldosterone system (RAAS), but the effect of vitamin D supplementation on the RAAS is inconclusive. Design. In this prespecified secondary analysis of a randomized controlled trial, we assessed in 165 patients with heart failure (vitamin D group: n=83; placebo group: n=82) the effect of three years of vitamin D supplementation with 4000 IU daily on parameters of the RAAS (renin and aldosterone) and on circulating 1,25(OH)2D, plasma phosphate, and fibroblast growth factor (FGF)-23. We assessed age- and baseline-adjusted between-group differences at study termination. Results. Almost all patients were under treatment with beta-blockers, inhibitors of the RAAS, and diuretics. Initially, the frequency of concentrations above the laboratory-specific reference range (renin: >23.9 mIU/L; aldosterone: >232 ng/L) in the vitamin D and placebo group was 87.7% and 92.7%, respectively (renin), and 24.1% and 32.5%, respectively (aldosterone). Vitamin D increased adjusted 1,25(OH)2D concentrations significantly (mean treatment effect and 95% CI: 18.3 pmol/L,7.3 to 29.3 pmol/L; P<0.001) but had no significant effects on phosphate (0.18 mmol/L, −0.00 to 0.35 mmol/L; P=0.051), FGF-23 (685 RU/mL, −213 to 1585 RU/mL; P=0.134), renin (312 mIU/L, −279 to 902 ng/L; P=0.298), or aldosterone (−0.19 ng/L, −5.09 to 4.70 ng/L; P=0.938). Vitamin D supplementation was, however, associated with an increase in renin concentrations in the subgroup with baseline 25-hydroxyvitamin D below 30 nmol/L (n=67; 1365 mIU/, 343 to 2386 mIU/L; P=0.010). Conclusions. In patients with advanced heart failure treated according to evidence-based guidelines, vitamin D supplementation did not significantly influence parameters of the RAAS in the entire study cohort but was associated with an increase in plasma renin concentrations in the subgroup with low baseline 25-hydroxyvitamin D concentrations.http://dx.doi.org/10.1155/2018/5015417 |
| spellingShingle | Armin Zittermann Jana B. Ernst Sylvana Prokop Uwe Fuchs Jens Dreier Joachim Kuhn Cornelius Knabbe Jochen Börgermann Heiner K. Berthold Stefan Pilz Ioanna Gouni-Berthold Jan F. Gummert Effects of Vitamin D Supplementation on Renin and Aldosterone Concentrations in Patients with Advanced Heart Failure: The EVITA Trial International Journal of Endocrinology |
| title | Effects of Vitamin D Supplementation on Renin and Aldosterone Concentrations in Patients with Advanced Heart Failure: The EVITA Trial |
| title_full | Effects of Vitamin D Supplementation on Renin and Aldosterone Concentrations in Patients with Advanced Heart Failure: The EVITA Trial |
| title_fullStr | Effects of Vitamin D Supplementation on Renin and Aldosterone Concentrations in Patients with Advanced Heart Failure: The EVITA Trial |
| title_full_unstemmed | Effects of Vitamin D Supplementation on Renin and Aldosterone Concentrations in Patients with Advanced Heart Failure: The EVITA Trial |
| title_short | Effects of Vitamin D Supplementation on Renin and Aldosterone Concentrations in Patients with Advanced Heart Failure: The EVITA Trial |
| title_sort | effects of vitamin d supplementation on renin and aldosterone concentrations in patients with advanced heart failure the evita trial |
| url | http://dx.doi.org/10.1155/2018/5015417 |
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