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Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial^1,2,3

¹ From the Institute of Nutrition and Food Science, University of Bonn, Bonn, Germany (SSS and PS); the Heart Center Nordrhein-Westfalen, Department of Cardio-Thoracic Surgery, Bad Oeynhausen, Germany (SSS, AZ, GT, and RK); and the Drug Commission of the German Medical Association, Berlin, Germany (HKB)

Background:Elevated circulating concentrations of proinflammatory cytokines may contribute to the pathogenesis of congestive heart failure (CHF). In vitro studies suggest that vitamin D suppresses proinflammatory cytokines and increases antiinflammatory cytokines.

Objective:We evaluated the effect of vitamin D supplementation on the survival rate and different biochemical variables in patients with CHF.

Design:One hundred twenty-three patients randomly received either 50 µg vitamin D₃/d plus 500 mg Ca/d [D(+) group] or placebo plus 500 mg Ca/d [D(–) group] for 9 mo. Biochemical variables were assessed at baseline and after 9 mo. The survival rate was calculated for a follow-up period of 15 mo.

Results:Ninety-three patients completed the study. Significant treatment effects were observed on logarithmic-transformed serum concentrations of 25-hydroxyvitamin D (P = 0.001), parathyroid hormone (P = 0.007), tumor necrosis factor (P = 0.006), and interleukin 10 (P = 0.042). 25-Hydroxyvitamin D increased by 26.8 ng/mL in the D(+) group but increased only by 3.6 ng/mL in the D(–) group. Compared with baseline, parathyroid hormone was significantly lower and the antiinflammatory cytokine interleukin 10 was significantly higher in the D(+) group after 9 mo. The proinflammatory cytokine tumor necrosis factor increased in the D(–) group but remained constant in the D(+) group. The survival rate did not differ significantly between the study groups during the follow-up period.

Conclusions:Vitamin D₃ reduces the inflammatory milieu in CHF patients and might serve as a new antiinflammatory agent for the future treatment of the disease. Our data provide evidence for the involvement of an impaired vitamin D–parathyroid hormone axis in the progression of CHF.

Key Words: Congestive heart failure • vitamin D • cytokine • parathyroid hormone

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