The effect of vitamin D deficiency on disease severity in chronic heart failure
Authors
Almammadov F. Ch.
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Objective. The aim of this study was to investigate the role of certain biochemical parameters in the relationship between vitamin D levels and the severity of chronic heart failure (CHF).
Materials and Methods. The study included 219 patients with CHF aged 30–89 years: 123 patients (mean age 60.4 ± 1.0 years) with NYHA class I–II and 96 patients (mean age 62.9 ± 1.0 years) with NYHA class III–IV. Blood samples were analyzed for creatinine, vitamin D, calcium, phosphorus, parathyroid hormone (PTH), endothelin-1, and fibroblast growth factor-23 (FGF-23). Left ventricular ejection fraction (EF) was measured using echocardiography.
Results. In patients with NYHA class I–II CHF, the serum concentration of vitamin D decreased by approximately 50% compared to the control group (p<0.001), while in NYHA class III–IV the decrease reached 2.5-fold (p<0.001). Calcium levels were reduced mainly in NYHA class III–IV patients by 9.3% (p<0.001). Phosphorus concentrations increased significantly both in the early and advanced stages of CHF, by 58.6% (p<0.001) and 62.0% (p<0.001), respectively. Compared with controls, PTH, endothelin-1, and FGF-23 levels were elevated in NYHA class I–II by 54.2% (p<0.001), 10.8% (p=0.003), and 53.1% (p<0.001), respectively; in NYHA class III–IV, the increases were 95% (p<0.001), 20.0% (p<0.001), and 62.3% (p<0.001), respectively. Correlation analysis revealed a statistically significant positive correlation between vitamin D levels and EF, whereas negative correlations were observed between vitamin D and PTH, FGF-23, and endothelin-1. These findings indicate that heart failure progresses through both metabolic and immunological mechanisms.
Conclusion. The present study demonstrated that vitamin D deficiency in patients with CHF worsens progressively with higher NYHA functional classes, and this deficiency is closely associated with alterations in several biochemical markers. A strong positive correlation was established between vitamin D levels and EF. These results confirm the essential regulatory role of vitamin D in the cardiovascular system.
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Authors
Almammadov F. Ch.
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References:
Kampka, Z.; Czapla, D.; Wojakowski, W.; Stanek, A. Vitamin D Supplementation in Heart Failure—Confusion Without a Cause? Nutrients 2025, 17, 1839. https://doi.org/ 10.3390/nu17111839 -1
Iyngkaran P., Thomas M., Horowitz J.D., Komesaroff P., Jelinek M., Hare D.L. Common Comorbidities that Alter Heart Failure Prognosis—Shaping New Thinking for Practice. Curr. Cardiol. Rev. 2021;17:e160721187934. doi: 10.2174/1573403X1666620111 3093548 -3
Mohanty V., Pathania M., Bhasi A. Effect of vitamin supplementation in patients of congestive heart failure deficient in vitamin D: A study at a tertiary care center of North India. Ann. Afr. Med. 2022;21:107–112. doi: 10.4103/aam.aam_70_20. -14
Deng C., Wu Y. Vitamin D-Parathyroid Hormone-Fibroblast Growth Factor 23 Axis and Cardiac Remodeling. Am. J. Cardiovasc. Drugs. 2025;25:25–36. doi: 10.1007/s40256-024-00688-8 -10
Hagău A.C., Pușcaș A., Togănel R., Muntean I. Is Hypovitaminosis D a Risk Factor for Heart Failure? Life. 2023;13:372. doi: 10.3390/life13020372. -12
Busa V., Dardeir A., Marudhai S., Patel M., Subas S.V., Ghani M.R., Cancarevic I. Role of Vitamin D Supplementation in Heart Failure Patients with Vitamin D Deficiency and Its Effects on Clinical Outcomes: A Literature Review. Cureus. 2020;12:e10840. doi: 10.7759/cureus.10840 -13
Vergaro, G., Del Franco, A., Aimo, A. et al. Intact fibroblast growth factor 23 in heart failure with reduced and mildly reduced ejection fraction. BMC Cardiovasc Disord 23, 433 (2023). https://doi.org/10.1186/s12872-023-03441-2.
Faul C. FGF23 effects on the heart-levels, time, source, and context matter. Kidney Int. 2018 Jul;94(1):7-11. doi: 10.1016/j.kint.2018.03.024. PMID: 29933856.
Bae S, Singh SS, Yu H, Lee JY, Cho BR, Kang PM. Vitamin D signaling pathway plays an important role in the development of heart failure after myocardial infarction. J Appl Physiol (1985). 2013 Apr;114(8):979-87. doi: 10.1152/japplphysiol.01506.2012. -16
Dentino P, Mora J, Zuo L (August 13, 2025) Vitamin D Deficiency and Its Role in Pathologies of Oxidative Stress: A Literature Review. Cureus 17(8): e90042. doi:10.7759/cureus.90042
Murray SL, Wolf M. Calcium and Phosphate Disorders: Core Curriculum 2024. Am J Kidney Dis. 2024 Feb;83(2):241-256. doi: 10.1053/j.ajkd.2023.04.017. Epub 2023 Dec 13. PMID: 38099870.
Belen E, Tipi FF, Aykan AC, Findikçioğlu U, Karakuş G, Yeşil A, Helvaci A, Kalaycioğlu E, Cetin M. Clinical staging in chronic heart failure associated with low vitamin D and elevated parathormone levels. Acta Cardiol. 2014 Dec;69(6):665-71. doi: 10.2143/AC.69.6.1000009. PMID: 25643437.
Scialla JJ, Wolf M. Roles of phosphate and fibroblast growth factor 23 in cardiovascular disease. Nat Rev Nephrol. 2014 May;10(5):268-78. doi: 10.1038/nrneph.2014.49. Epub 2014 Apr 1. PMID: 24686452.-18
Stöhr R, Schuh A, Heine GH, Brandenburg V. FGF23 in Cardiovascular Disease: Innocent Bystander or Active Mediator? Front Endocrinol (Lausanne). 2018 Jun 27;9:351. doi: 10.3389/fendo.2018.00351. Erratum in: Front Endocrinol (Lausanne). 2018 Jul 18;9:422. doi: 10.3389/fendo.2018.00422.
Batra J, Buttar RS, Kaur P, Kreimerman J, Melamed ML. FGF-23 and cardiovascular disease: review of literature. Curr Opin Endocrinol Diabetes Obes. 2016 Dec;23(6):423-429. doi: 10.1097/MED.0000000000000294. PMID: 27652999; PMCID: PMC6936216.
Binnenmars, S. H., Hoogslag, G. E., Yeung, S. M. H., Brouwers, F. P., Bakker, S. J. L., van Gilst, W. H., Gansevoort, R. T., Navis, G., Voors, A. A., & de Borst, M. H. (2022). Fibroblast growth factor 23 and risk of new onset heart failure with preserved or reduced ejection fraction: The PREVEND study. Journal of the American Heart Association, 11(15), e024952. https://doi.org/10.1161/JAHA.121.02495
Nakano T, Kishimoto H, Tokumoto M. Direct and indirect effects of fibroblast growth factor 23 on the heart. Front Endocrinol (Lausanne). 2023 Feb 24;14:1059179. doi: 10.3389/fendo.2023.1059179. PMID: 36909314; PMCID: PMC9999118.
Silswal N, Touchberry CD, Daniel DR, McCarthy DL, Zhang S, Andresen J, Stubbs JR, Wacker MJ. FGF23 directly impairs endothelium-dependent vasorelaxation by increasing superoxide levels and reducing nitric oxide bioavailability. Am J Physiol Endocrinol Metab. 2014 Sep 1;307(5):E426-36. doi: 10.1152/ajpendo.00264.2014. Epub 2014 Jul 22. PMID: 25053401; PMCID: PMC4154070.
Dmour BA, Badescu MC, Tuchiluș C, Cianga CM, Constantinescu D, Dima N, Duca ȘT, Dmour A, Costache AD, Cepoi MR, Crișan A, Leancă SA, Loghin C, Șerban IL, Costache-Enache II. Can Endothelin-1 Help Address the Diagnostic and Prognostic Challenges in Multimorbid Acute Heart Failure Patients? Life (Basel). 2025 Apr 9;15(4):628. doi: 10.3390/life15040628. -36
Shantsila E, Wrigley BJ, Blann AD, Gill PS, Lip GY. A contemporary view on endothelial function in heart failure. Eur J Heart Fail. 2012 Aug;14(8):873-81. doi: 10.1093/eurjhf/hfs066. Epub 2012 Jun 7. PMID: 22677484. -37
Woo JS, Woo Y, Jang JY, Ha SJ. Effect of vitamin D on endothelial and ventricular function in chronic heart failure patients: A prospective, randomized, placebo-controlled trial. Medicine (Baltimore). 2022 Jul 22;101(29):e29623. doi: 10.1097/MD.0000000000029623. -38
Feger M, Ewendt F, Menzel M, Hocher B, Föller M. Endothelin receptor B controls the production of fibroblast growth factor 23. FASEB J. 2020 May;34(5):6262-6270. doi: 10.1096/fj.201903109R. Epub 2020 Mar 11. PMID: 32157737.
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