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Tafteh N, Rezaeian S, Abdollahzad H, Sabzi F. The Association of Serum Vitamin D With Anthropometric Indices, Lipid Profile, ICAM-1, and IL-17 in Patients Undergoing Coronary Artery Bypass Graft Surgery. Clin Nutr Res 2024; 13:165-175. [PMID: 39165290 PMCID: PMC11333149 DOI: 10.7762/cnr.2024.13.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 08/22/2024] Open
Abstract
This study aimed to assess the relationship between serum levels of vitamin D with anthropometric indices, lipid profile and vascular inflammatory factors, in patients who candidate for coronary artery bypass grafting (CABG). This analytical cross-sectional study was conducted in patients who were candidate for CABG. Demographic information, medical records, anthropometric indicators, blood samples, and physical activity of 150 patients were collected. 146 participants with mean ± standard deviation of age: 61.8 ± 10.0 years and body mass index: 26.9 ± 3.7 kg/m2 completed the study. Based on serum levels of vitamin D, patients were divided into 2 groups; groups with sufficient (≥ 30 ng/mL) and insufficient amount of vitamin D (< 30 ng/mL). The 30.14% of the patients had serum vitamin D deficiency. Ejection fraction (EF) % between the 2 groups had significant difference. Unexpectedly the EF% increased 7% in patients with insufficient level of vitamin D (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.11; p = 0.001). Vitamin D status had a significant inverse association with body weight. The odds of vitamin D deficiency significantly increased by 4% with increasing one kg in weight (OR, 1.04; 95% CI, 1-1.08; p = 0.044). There were no significant association between serum vitamin D level and intra cellular adhesion molecule-1, interleukin-17, fasting blood glucose, and lipid profile (p > 0.05). Considering the inverse association observed between serum vitamin D with EF% and body weight, vitamin D may play a role in modulating of these indices.
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Affiliation(s)
- Nazanin Tafteh
- Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
| | - Hadi Abdollahzad
- Department of Nutrition, School of Medicine, Urmia University of Medical Sciences, Urmia 5756115111, Iran
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia 5756115111, Iran
| | - Feridoun Sabzi
- Department of General Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
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Gut Microbiota in Patients with Postoperative Atrial Fibrillation Undergoing Off-Pump Coronary Bypass Graft Surgery. J Clin Med 2023; 12:jcm12041493. [PMID: 36836027 PMCID: PMC9960524 DOI: 10.3390/jcm12041493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Post-operative atrial fibrillation (POAF) is one of the most common complications of cardiac surgery. However, the underlying mechanism is not well understood. Alterations in the gut microbiota are associated with the development of atrial fibrillation (AF). The aim of this study was to explore the relationship between gut microbiota and POAF. METHODS Fecal samples were collected before surgery from 45 patients who underwent coronary artery bypass grafting with POAF and 90 matched patients without POAF (1:2). 16S rRNA sequencing was used to detect the microbiome profiles of 45 POAF patients and 89 matched patients (one sample in the no-POAF group was deleted owing to low quality after sequencing). Plasma 25-hydroxy vitamin D level was measured by ELISA. RESULTS Compared to the patients without POAF, gut microbiota composition was remarkably changed in the patients with POAF, with an increase in Lachnospira, Acinetobacter, Veillonella and Aeromonas, and a decrease in Escherichia-Shigella, Klebsiella, Streptococcus, Brevundimonas and Citrobacter. Furthermore, plasma 25-hydroxy vitamin D levels were decreased in POAF patients and negatively correlated with an abundance of Lachnospira. CONCLUSIONS The gut microbiota composition between patients with and without POAF is significantly different, implying that gut microbiota may play a role in the pathogenesis of POAF. Further studies are needed to fully clarify the role of gut microbiota in the initiation of AF.
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Effat Fakhry E, Tawfik Ibrahim M. Relationship between vitamin D deficiency and success of cardioversion in patients with atrial fibrillation. Herzschrittmacherther Elektrophysiol 2022; 33:209-216. [PMID: 35258692 DOI: 10.1007/s00399-022-00846-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Inflammation plays an important role in the pathogenesis of atrial fibrillation (AF). Vitamin D deficiency has been found to increase vulnerability to AF. The authors aimed to determine the relationship between vitamin D deficiency and cardioversion success in AF patients. METHODS The study included 200 persistent AF patients presenting for cardioversion. Serum vitamin D level was sampled on admission. The success of cardioversion was assessed and patients divided into two groups: successful or failed (group I and II, respectively). Vitamin D level was assessed and patients were divided into three groups: deficient, insufficient, and sufficient vitamin D level. Cardioversion was performed pharmacologically or electrically. Failure of cardioversion was defined as: (1) detection of AF rhythm in 12-lead ECG recording immediately after cardioversion or within 6‑month follow-up, or (2) ECG Holter monitoring of AF lasting > 30 s at 6‑month follow-up. RESULTS There was a highly statistically significant difference in baseline serum vitamin D level between group I and group II (P-value < 0.01). There were no statistically significant differences between the three groups in terms of vitamin D levels regarding age, gender, body mass index, smoking, and left atrial diameter. CONCLUSION This study demonstrated that AF cardioversion failure was associated with vitamin D deficiency in patients without structural heart disease, while sufficient and insufficient vitamin D levels were associated with successful cardioversion. Therefore, vitamin D level assessment before cardioversion may help predict the success of cardioversion, and possible correction of deficient vitamin D levels may increase the chance of successful cardioversion.
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The Pathogenesis of Cardiac Arrhythmias in Vitamin D Deficiency. Biomedicines 2022; 10:biomedicines10061239. [PMID: 35740261 PMCID: PMC9220304 DOI: 10.3390/biomedicines10061239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
The global prevalence of vitamin D deficiency is more than 20%, and the main causes include insufficient intake, reduced absorption, abnormal metabolism, or resistance to its effects. The levels of serum vitamin D appear to influence cardiovascular risk, and the mechanism involved is linked to the transient outward current and the ultrarapid delayed rectifier K+ current densities, activated through the nuclear vitamin D receptor and Akt pathway. A significant number of studies have correlated vitamin D deficiency with an increased risk of developing cardiac arrhythmias and sudden cardiac death. For this reason, the purpose of this review is to analyze the relation between vitamin D deficiency and the pathogenesis of cardiac arrhythmias. Atrial fibrillation, increased QT interval, and QT dispersion were the most common findings associated with vitamin D deficiency. Due to the heterogeneity among existing studies, further research is necessary to confirm the existing data and to analyze its relationship with other types of arrhythmias.
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Ghafouri K, Franke KB, Foo FS, Stiles MK. Clinical utility of cardiac magnetic resonance imaging to assess the left atrium before catheter ablation for atrial fibrillation - A systematic review and meta-analysis. Int J Cardiol 2021; 339:192-202. [PMID: 34303756 DOI: 10.1016/j.ijcard.2021.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/04/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
AIMS This systematic review and meta-analysis aims to clarify the role of pre-procedural cardiac magnetic resonance imaging (MRI) in identifying the association between left atrial (LA) characteristics and post-ablation atrial fibrillation (AF) recurrence. These characteristics include LA fibrosis, emptying function, sphericity, volume, volume index, peak strain and post-contrast T1 relaxation time. METHODS PubMed, EMBASE, and Cochrane were searched up to July 2020 for English language articles reporting the use of cardiac MRI in catheter ablation for AF. Studies reporting the prognostic value of pre-ablation cardiac MRI were included. All references and citations were filtered for relevant manuscripts. RESULTS Twenty-four publications were identified. Every 10% increase in LA fibrosis was associated with a 1.54-fold increase in post-ablation AF recurrence (95%CI: 1.39-1.70, I2 = 50.1%). Every 10 ml increase in LA volume resulted in a hazard ratio of 1.07 (95%CI:1.03-1.12; I2 = 41.4%) for post-ablation AF recurrence. For LA sphericity, there was no significant association with post-ablation AF recurrence (HR: 1.032 [95%CI: 0.962-1.103, I2 = 49.6%). Egger's test was non-significant for publication bias in all meta-analyses. LA volume index, emptying function, peak strain and post-contrast LA T1 relaxation time had insufficient compatible publications to conduct a meta-analysis. CONCLUSION LA fibrosis quantified by cardiac MRI is associated with risk of AF recurrence after AF ablation, while increased LA volume is associated with AF recurrence to a lesser extent. There remains insufficient evidence to support the routine measurement of LA sphericity, LA volume index, LA emptying function, peak strain and LA T1 relaxation time to predict AF recurrence after AF ablation.
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Affiliation(s)
- Khashayar Ghafouri
- The university of Auckland, Faculty of Medical and Health Sciences, 85 Park Road, Grafton, 1023 Auckland, New Zealand..
| | - Kyle B Franke
- The University of Adelaide, Adelaide Medical School, North Terrace, Adelaide, South Australia 5005, Australia
| | - Fang Shawn Foo
- Peter Rothwell Academic Centre, Waikato Hospital, Pembroke Street, 3240 Hamilton, New Zealand; North Shore Hospital, 124 Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
| | - Martin K Stiles
- The university of Auckland, Faculty of Medical and Health Sciences, 85 Park Road, Grafton, 1023 Auckland, New Zealand.; Peter Rothwell Academic Centre, Waikato Hospital, Pembroke Street, 3240 Hamilton, New Zealand
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Izzo M, Carrizzo A, Izzo C, Cappello E, Cecere D, Ciccarelli M, Iannece P, Damato A, Vecchione C, Pompeo F. Vitamin D: Not Just Bone Metabolism but a Key Player in Cardiovascular Diseases. Life (Basel) 2021; 11:life11050452. [PMID: 34070202 PMCID: PMC8158519 DOI: 10.3390/life11050452] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022] Open
Abstract
Vitamin D is the first item of drug expenditure for the treatment of osteoporosis. Its deficiency is a condition that affects not only older individuals but also young people. Recently, the scientific community has focused its attention on the possible role of vitamin D in the development of several chronic diseases such as cardiovascular and metabolic diseases. This review aims to highlight the possible role of vitamin D in cardiovascular and metabolic diseases. In particular, here we examine (1) the role of vitamin D in diabetes mellitus, metabolic syndrome, and obesity, and its influence on insulin secretion; (2) its role in atherosclerosis, in which chronic vitamin D deficiency, lower than 20 ng/mL (50 nmol/L), has emerged among the new risk factors; (3) the role of vitamin D in essential hypertension, in which low plasma levels of vitamin D have been associated with both an increase in the prevalence of hypertension and diastolic hypertension; (4) the role of vitamin D in peripheral arteriopathies and aneurysmal pathology, reporting that patients with peripheral artery diseases had lower vitamin D values than non-suffering PAD controls; (5) the genetic and epigenetic role of vitamin D, highlighting its transcriptional regulation capacity; and (6) the role of vitamin D in cardiac remodeling and disease. Despite the many observational studies and meta-analyses supporting the critical role of vitamin D in cardiovascular physiopathology, clinical trials designed to evaluate the specific role of vitamin D in cardiovascular disease are scarce. The characterization of the importance of vitamin D as a marker of pathology should represent a future research challenge.
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Affiliation(s)
- Marcello Izzo
- Department of Mathematics for Technology, Medicine and Biosciences Research Center, University of Ferrara, 44121 Ferrara, Italy
- Specialist Medical Center-Via Cimitile, 80035 Nola, Italy
- Correspondence:
| | - Albino Carrizzo
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Enrico Cappello
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Domenico Cecere
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Patrizia Iannece
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Antonio Damato
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Carmine Vecchione
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Francesco Pompeo
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
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Yaman B, Cerit L, Günsel HK, Cerit Z, Usalp S, Yüksek Ü, Coşkun U, Duygu H, Akpınar O. Is there any Link Between Vitamin D and Recurrence of Atrial Fibrillation after Cardioversion? Braz J Cardiovasc Surg 2020; 35:191-197. [PMID: 32369300 PMCID: PMC7199985 DOI: 10.21470/1678-9741-2019-0166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is the most common chronic arrhythmia in the elderly population. In symptomatic patients, restoration and maintenance of sinus rhythm improve quality of life. Unfortunately, AF recurrence still occurs in a considerable number of patients after cardioversion (CV). In this study, we aimed to evaluate the association between vitamin D (VitD) and AF recurrence after electrical or medical CV. Method A total of 51 patients who underwent CV for symptomatic AF were included in the study. AF recurrence was defined as an AF pattern in 12-lead electrocardiography (ECG) recording after CV within 6 months or ECG Holter recording of AF lasting more than 30 seconds at 6-month follow-up. Results Mean vitD level was 21.4 ng/ml in our study population. VitD level was lower in the AF recurrence group than in the non-recurrence group (18 ng/ml vs. 26.3 ng/ml, respectively; P=0.001). Additionally, left atrial diameter was larger in the AF recurrence group compared to the non-recurrence group (4.4 vs. 4.1, P=0.025). Patients with AF recurrence were older than patients without AF recurrence, and, although the prevalence of hypertension is higher in the AF recurrence group, there was no statistically significant difference (P=0.107, P=0.867). Conclusion In our study, there is a strong association between vitD level and AF recurrence after CV. VitD deficiency might be a predictor of high risk of AF recurrence after CV and vitD supplementation during the follow-up might help the maintenance of sinus rhythm.
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Affiliation(s)
- Belma Yaman
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Levent Cerit
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Hatice Kemal Günsel
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Zeynep Cerit
- Near East University Department of Pediatric Cardiology Nicosia Cyprus Department of Pediatric Cardiology, Near East University, Nicosia, Cyprus
| | - Songül Usalp
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Ümit Yüksek
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Uğur Coşkun
- University of Kyrenia Faculty of Medicine Department of Cardiology Kyrenia Cyprus Department of Cardiology, University of Kyrenia Faculty of Medicine, Kyrenia, Cyprus
| | - Hamza Duygu
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Onur Akpınar
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
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Abstract
Atrial fibrillation is a common type of arrhythmia and is an important cause of
stroke and heart failure. vitamin D is an emerging risk factor of AF, and is
implicated in the pathophysiology of atrial fibrillation. It has been
established that this vitamin is extensively involved in the regulation of both
the renin angiotensin aldosterone system and the immune system. Epidemiological
studies have not yet reached a consensus on the possible association between
vitamin D deficiency and atrial fibrillation. Better research designs and
methods can further clarify the relationship between the two.
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Affiliation(s)
- Lizhan Bie
- Third People's Hospital of Yancheng Department of Cardiology Yancheng China Department of Cardiology, the Third People's Hospital of Yancheng, Yancheng, China
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9
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Liu X, Wang W, Tan Z, Zhu X, Liu M, Wan R, Hong K. The relationship between vitamin D and risk of atrial fibrillation: a dose-response analysis of observational studies. Nutr J 2019; 18:73. [PMID: 31727055 PMCID: PMC6857145 DOI: 10.1186/s12937-019-0485-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022] Open
Abstract
Background The relationship between serum vitamin D and atrial fibrillation (AF) or postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass graft (CABG) is still debated. It is also unclear whether there is a dose-response relationship between circulating vitamin D and the risk of AF or POAF. Methods The Cochrane Library, PubMed, and Embase databases were searched for relevant studies. We used a “one-stage approach” with a restricted cubic spline model to summarize the dose-specific relationships between serum vitamin D and AF. Relative risk (RR) was used to measure the effects in this meta-analysis. Results In total, 13 studies were included with a total of 6519 cases of AF among 74,885 participants. Vitamin D deficiency (< 20 ng/ml) was associated with increased risks of AF (RR: 1.23, 95% CI: 1.05–1.43). In the dose-response analysis, the summary RR for a 10 ng/ml increased in vitamin D was 0.88 (95% CI: 0.78–0.98) and there was no evidence of a non-linear association, Pnon-linearity = 0.86. In the age subgroup, high vitamin D (per 10 ng/ml increase) reduced the risk of AF in the older group (> 65 years) (RR = 0.68, 95% CI = 0.52–0.89) but not among young individuals (< 65 years) (RR = 0.87, 95% CI = 0.72–1.06). In addition, a strong association was found between a 10 ng/ml increased in vitamin D and POAF incident in the patient after CABG (RR: 0.44, 95% CI: 0.24–0.82). Conclusion Our dose-response meta-analysis suggested serum vitamin D deficiency was associated with an increased risk of AF in the general population and POAF in patients after CABG. Further studies are needed to explore the age difference in the association between serum vitamin D level and the risk of AF and whether vitamin D supplements will prevent AF. Trial registration This study has been registered with PROSPERO (International prospective register of systematic reviews)-registration number-CRD42019119258.
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Affiliation(s)
- Xiao Liu
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Wei Wang
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhaochong Tan
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xin Zhu
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Menglu Liu
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Rong Wan
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Kui Hong
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China. .,Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi, China.
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10
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Li B, Luo F, Luo X, Li B, Qi L, Zhang D, Tang Y. Effects of atrial fibrosis induced by mitral regurgitation on atrial electrophysiology and susceptibility to atrial fibrillation in pigs. Cardiovasc Pathol 2019; 40:32-40. [DOI: 10.1016/j.carpath.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 01/28/2023] Open
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Cerit L, Günsel A, Cerit Z, Gediz B, Duygu H. Vitamin D as a predictor of arrhythmia recurrence after balloon cryoablation. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2018. [DOI: 10.23736/s0393-3660.17.03680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yang HY, Huang JH, Chiu HW, Lin YK, Hsu CY, Chen YJ. Vitamin D and bisphosphonates therapies for osteoporosis are associated with different risks of atrial fibrillation in women: A nationwide population-based analysis. Medicine (Baltimore) 2018; 97:e12947. [PMID: 30412111 PMCID: PMC6221698 DOI: 10.1097/md.0000000000012947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Osteoporosis and atrial fibrillation (AF) are common in post-menopausal women. Vitamin D and bisphosphonates are widely used to treat osteoporosis, and these may have different effects on the risk of AF.The goal of this study was to evaluate whether different agents for treating osteoporosis modulate the risk of AF in a population-based database.We identified 20,788 female patients suffering from osteoporosis who were or were not treated with vitamin D or bisphosphonates using the Taiwan National Health Insurance nationwide database from 2000 to 2008 and followed them up for 5 consecutive years to determine if they had a new diagnosis of AF after the diagnosis of osteoporosis.There were 14 (2.67%) new AF diagnoses in osteoporosis patients treated with bisphosphonates, one (0.28%) new AF diagnosis in patients treated with vitamin D, and 279 (1.40%) new AF diagnoses in patients who were not treated with vitamin D or bisphosphonates (neither group). Osteoporosis patients who received bisphosphonates showed a higher incidence of AF occurrence than those that were not treated with bisphosphonates (P = .015). In contrast, 1 patient who received vitamin D had a new diagnosis of AF during the study period; thus, the incidence was significantly lower than that in the patients treated with bisphosphonates (P = .007). In addition, the patients who were treated with vitamin D had a lower incidence of AF than did those who were not treated with either vitamin D or bisphosphonates (P = .074). Kaplan-Meier analysis also showed a significant difference in AF occurrence in different groups during the 5-year follow-up (P = .010).Different treatment for osteoporosis may carry diverse risks of AF occurrence. Vitamin D may have potential beneficial effects of reducing AF occurrence in osteoporosis patients.
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Affiliation(s)
- Hung-Yu Yang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology
- Department of Internal Medicine, School of Medicine, College of Medicine
| | - Jen-Hung Huang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital
- Department of Internal Medicine, School of Medicine, College of Medicine
| | - Hung-Wen Chiu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital
- Department of Internal Medicine, School of Medicine, College of Medicine
| | - Chien-Yeh Hsu
- Department of Information Management, National Taipei University of Nursing and Health Sciences
- Master Program in Global Health and Development
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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13
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Turin A, Bax JJ, Doukas D, Joyce C, Lopez JJ, Mathew V, Pontone G, Shah F, Singh S, Wilber DJ, Rabbat MG. Interactions Among Vitamin D, Atrial Fibrillation, and the Renin-Angiotensin-Aldosterone System. Am J Cardiol 2018; 122:780-784. [PMID: 30057228 DOI: 10.1016/j.amjcard.2018.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 11/17/2022]
Abstract
Blockade of the renin-angiotensin-aldosterone system (RAAS) with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB) has been shown to decrease incident atrial fibrillation (AF). Vitamin D deficiency has been implicated but associations between vitamin D and AF are inconsistent. However, vitamin D deficiency results in renin and angiotensin upregulation. This study seeks to determine the relation between vitamin D deficiency and incident AF and characterize this relation in the setting of RAAS inhibition. A total of 47,062 patients with 25-hydroxyvitamin D [25(OH)D] laboratory testing were retrospectively identified. Clinical information was extracted from the medical record. The primary outcome was incidence of AF. Given significant patient variation, propensity score matching was used to select comparable groups of those who initiated ACEI/ARB ("AI") versus those who did not ("NAI"). Odds ratios (ORs) for incident AF associated with ACEI/ARB initiation and 25(OH)D level were estimated using generalized linear mixed models. AI patients had less incident AF than NAI patients (OR 0.36, 95% confidence interval [CI] 0.32 to 0.39) consistent with previous studies, but 25(OH)D deficiency was not associated with incident AF (OR 1.08, 95% CI 0.95 to 1.22). When stratified by 25(OH)D, there was a statistically significant decreased rate of AF in AI patients. Interestingly, this benefit was attenuated in 25(OH)D deficiency (deficient: OR 0.48, 95% CI 0.38 to 0.60 vs normal: OR 0.34, 95% CI 0.30 to 0.37). In conclusion, 25(OH)D deficiency was not associated with incident AF, and the benefit of ACE/ARB use was attenuated in 25(OH)D deficiency; this suggests that 25(OH)D may act as a cofactor in the mitigation of AF by RAAS inhibition.
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Affiliation(s)
- Alexander Turin
- Loyola University Medical Center, Department of Internal Medicine, Maywood, Illinois
| | - Jeroen J Bax
- Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
| | - Demetrios Doukas
- Loyola University Medical Center, Department of Internal Medicine, Division of Cardiology, Maywood, Illinois
| | - Cara Joyce
- Loyola University Medical Center, Department of Public Health Sciences, Maywood, Illinois
| | - John J Lopez
- Loyola University Medical Center, Department of Internal Medicine, Division of Cardiology, Maywood, Illinois
| | - Verghese Mathew
- Loyola University Medical Center, Department of Internal Medicine, Division of Cardiology, Maywood, Illinois
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Department of Cardiovascular Imaging, Milan, Italy
| | - Falak Shah
- Carle Foundation Hospital, Urbana, Illinois
| | - Sanjay Singh
- Hines VA Medical Center, Research Services, Hines, Illinois
| | - David J Wilber
- Loyola University Medical Center, Department of Internal Medicine, Division of Cardiology, Maywood, Illinois
| | - Mark G Rabbat
- Loyola University Medical Center, Department of Internal Medicine, Division of Cardiology, Maywood, Illinois.
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14
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Chan YH, Yiu KH, Hai JJ, Chan PH, Lam TH, Cowling BJ, Sham PC, Lau CP, Lam KSL, Siu CW, Tse HF. Genetically deprived vitamin D exposure predisposes to atrial fibrillation. Europace 2018; 19:iv25-iv31. [PMID: 29220424 DOI: 10.1093/europace/eux312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/11/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Low vitamin D level is associated with atrial fibrillation (AF) and may be implicated in its pathogenesis. Methods and results We studied single nucleotide polymorphisms (SNPs) of vitamin D mechanistic pathways and serum 25-hydroxyvitamin D [25(OH)D] levels in an age- and gender-matched case-control study (controls without AF: mean age 68.6 ± 8.7 years, female 25%; n = 1019; with AF: mean age 69.7 ± 9.5 years, female 30%; n = 156) recruited from a Chinese clinical cohort of patients with stable coronary artery disease. Twelve SNPs involved in the vitamin D mechanistic pathways were studied [biosynthetic: rs4646536, rs10877012, rs3829251, rs1790349; activation: rs2060793, rs1993116; vitamin D-binding protein (VBP)/group-specific component (GC): rs4588, rs7041, rs2282679, rs1155563; and vitamin D receptor: rs1544410, rs10735810]. A genetic risk score (GRS) (0-8) was constructed from SNPs associated with serum 25(OH)D as a proxy to lifelong vitamin D-deficient state. All 4 SNPs involved in the VBP/GC were significantly associated with serum 25(OH)D (rs4588, P < 0.001; rs2282679, P < 0.001; rs7041, P = 0.011; rs1155563, P < 0.001; all other SNPs, P > 0.05). Vitamin D GRS (points 0-8) generated from these 4 SNPs was independently predictive of serum 25(OH)D [B = 0.54, 95% confidence interval (CI) 0.30-0.79; P < 0.001]. Genetically deprived vitamin D status as denoted by a low GRS (0-3) independently predicted an increased risk of AF, compared to a high GRS (4-8) (odds ratio = 1.848, 95% CI 1.217-2.805; P = 0.004). Conclusion Genetically deprived vitamin D exposure predisposes to increased AF among patients with coronary artery disease. Whether VBP/GC may alter the risk of AF via alternative mechanisms warrants further studies.
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Affiliation(s)
- Yap-Hang Chan
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.,Research Center of Heart, Brain, Hormone and Healthy Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Jo Jo Hai
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Pak-Hei Chan
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Ben J Cowling
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Pak-Chung Sham
- Department of Psychiatry and Centre for Genomic Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Chu-Pak Lau
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Karen Siu-Ling Lam
- Research Center of Heart, Brain, Hormone and Healthy Ageing, The University of Hong Kong, Hong Kong SAR, China.,Division of Endocrinology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.,Research Center of Heart, Brain, Hormone and Healthy Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.,Research Center of Heart, Brain, Hormone and Healthy Ageing, The University of Hong Kong, Hong Kong SAR, China
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15
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Abstract
Vitamin D is critical in mineral homeostasis and skeletal health and plays a regulatory role in nonskeletal tissues. Vitamin D deficiency is associated with chronic inflammatory diseases, including diabetes and obesity, both strong risk factors for cardiovascular diseases (CVDs). CVDs, including coronary artery disease, myocardial infarction, hypertrophy, cardiomyopathy, cardiac fibrosis, heart failure, aneurysm, peripheral arterial disease, hypertension, and atherosclerosis, are major causes of morbidity and mortality. The association of these diseases with vitamin D deficiency and improvement with vitamin D supplementation suggest its therapeutic benefit. The authors review the findings on the association of vitamin D deficiency and CVDs.
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Affiliation(s)
- Vikrant Rai
- Department of Clinical and Translational Science, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE 68178, USA
| | - Devendra K Agrawal
- Department of Clinical and Translational Science, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE 68178, USA.
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