Heart failure is also called congestive heart failure (CHF). CHF occurs when the heart can no longer pump enough blood to the rest of the body.
Nearly 5 million Americans currently suffer from heart failure. Annually, about 550,000 new cases of CHF are now diagnosed and 300,000 die from the condition.
Risk factors for heart failure include:
- Coronary artery disease
- High blood pressure
- Diseases that damage or weaken the heart muscle or valves
Heart failure is most common in people who are:
- Greater than 65 years of age
- African-American, Hispanic, and Native American (Generally, these groups have higher blood pressure and more diabetes than white Americans.)
Sunlight exposure and risk of CHF
African-Americans may also have a higher risk of CHF because they have darker skin and lower vitamin D levels. African-Americans have 40% lower vitamin D blood levels than white Americans.
People living in the southern regions of Australia had a higher summer-winter difference in CHF mortality rates than those living in the northern regions. Solar ultraviolet-B (UVB) doses change more during the year in the southern regions than in the northern regions. This accounts for the seasonal variations in vitamin D levels.
Vitamin D and CHF
Vitamin D levels
A number of studies have found that people with CHF have lower vitamin D blood levels:
- British infants who were dark-skinned and breast fed had CHF.
- In Austria, people with suspected coronary heart disease and low vitamin D levels had nearly three times the risk of dying from CHF than those with adequate vitamin D levels.
- Patients who received heart transplants appeared to have low vitamin D levels.
- In two German studies, people with CHF and higher vitamin D levels had higher survival rates.
How vitamin D works
Vitamin D may lower the risk of CHF because it:
- Reduces the risk of diseases that may lead to CHF (high blood pressure, diabetes, and coronary heart disease)
- Strengthens the heart muscle
- Reduces inflammation
One study supports the theory that vitamin D reduces inflammation. Another study found little effect of vitamin D plus calcium supplements on CHF or quality of life.
There are no reported studies directly investigating increasing vitamin D levels to reduce the risk of CHF. However, observational studies support the fact that vitamin D may reduce the risk of CHF.
Based on studies of CHF and other diseases, it appears that vitamin D levels above 30–40 ng/mL (75–100 nmol/L) might reduce the risk of CHF.
Vitamin D and calcium
Children with rickets and severe heart failure can be successfully treated with vitamin D plus calcium.
The combination of vitamin D and calcium may help lower the risk of CHF. However, more studies are needed to confirm this.
This evidence summary was written by:
William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
- Abou-Raya, S. Abou-Raya, A. Osteoporosis and congestive heart failure (CHF) in the elderly patient: double disease burden. Archives of gerontology and geriatrics. 2009 Sep-Oct; 49 (2): 250-4.
- Agarwal, M. Phan, A. Willix, R., Jr. Barber, M. Schwarz, E. R. Is Vitamin D Deficiency Associated With Heart Failure? A Review of Current Evidence. Journal of cardiovascular pharmacology and therapeutics. 2011 Feb 8;
- Alsafwah, S. Laguardia, S. P. Arroyo, M. Dockery, B. K. Bhattacharya, S. K. Ahokas, R. A. Newman, K. P. Congestive heart failure is a systemic illness: a role for minerals and micronutrients. Clin Med Res. 2007 Dec; 5 (4): 238-43.
- Ameri, P. Ronco, D. Casu, M. Denegri, A. Bovio, M. Menoni, S. Ferone, D. Murialdo, G. High prevalence of vitamin D deficiency and its association with left ventricular dilation: an echocardiography study in elderly patients with chronic heart failure. Nutr Metab Cardiovasc Dis. 2010 Nov; 20 (9): 633-40.
- Barnett, A. G. de Looper, M. Fraser, J. F. The seasonality in heart failure deaths and total cardiovascular deaths. Aust N Z J Public Health. 2008 Oct; 32 (5): 408-13.
- Bui, A. L. Horwich, T. B. Fonarow, G. C. Epidemiology and risk profile of heart failure. Nature reviews. Cardiology. 2011 Jan; 8 (1): 30-41.
- Cioffi, G. Gatti, D. Adami, S. [Vitamin D deficiency, left ventricular dysfunction and heart failure]. Giornale italiano di cardiologia. 2010 Sep; 11 (9): 645-53.
- Drechsler, C. Pilz, S. Obermayer-Pietsch, B. Verduijn, M. Tomaschitz, A. Krane, V. Espe, K. Dekker, F. Brandenburg, V. Marz, W. Ritz, E. Wanner, C. Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients. Eur Heart J. 2010 Sep; 31 (18): 2253-61.
- Ginde, A. A. Liu, M. C. Camargo, C. A., Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009 Mar 23; 169 (6): 626-32.
- Hagström E, Ingelsson E, Sundström J, Hellman P, Larsson TE, Berglund L, Melhus H, Held C, Michaëlsson K, Lind L, Arnlöv J. Plasma parathyroid hormone and risk of congestive heart failure in the community. Eur J Heart Fail. 2010 Nov; 12 (11): 1186-92.
- Heaney, R. P. Recker, R. R. Grote, J. Horst, R. L. Armas, L. A. Vitamin D3 Is More Potent Than Vitamin D2 in Humans. J Clin Endocrinol Metab. 2010 Dec 22;
- Jablonski, K. L. Chonchol, M. Pierce, G. L. Walker, A. E. Seals, D. R. 25-Hydroxyvitamin D deficiency is associated with inflammation-linked vascular endothelial dysfunction in middle-aged and older adults. Hypertension. 2011 Jan; 57 (1): 63-9.
- Kalogeropoulos, A. Georgiopoulou, V. Psaty, B. M. Rodondi, N. Smith, A. L. Harrison, D. G. Liu, Y. Hoffmann, U. Bauer, D. C. Newman, A. B. Kritchevsky, S. B. Harris, T. B. Butler, J. Inflammatory markers and incident heart failure risk in older adults: the Health ABC (Health, Aging, and Body Composition) study. J Am Coll Cardiol. 2010 May 11; 55 (19): 2129-37.
- Lappe, J. M. Davies, K. M. Travers-Gustafson, D. Heaney, R. P. Vitamin D status in a rural postmenopausal female population. J Am Coll Nutr. 2006 Oct; 25 (5): 395-402.
- Maiya, S. Sullivan, I. Allgrove, J. Yates, R. Malone, M. Brain, C. Archer, N. Mok, Q. Daubeney, P. Tulloh, R. Burch, M. Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure. Heart. 2008 May; 94 (5): 581-4.
- Meems, L. M. van der Harst, P. van Gilst, W. H. de Boer, R. A. Vitamin D biology in heart failure: molecular mechanisms and systematic review. Curr Drug Targets. 2011 Jan; 12 (1): 29-41.
- Newman, K. P. Bhattacharya, S. K. Munir, A. Davis, R. C. Soberman, J. E. Ramanathan, K. B. Macro- and micronutrients in patients with congestive heart failure, particularly African-Americans. Vasc Health Risk Manag. 2007; 3 (5): 743-7.
- Newman, K. P. Neal, M. T. Roberts, M. Goodwin, K. D. Hatcher, E. A. Bhattacharya, S. K. The importance of lost minerals in heart failure. Cardiovasc Hematol Agents Med Chem. 2007 Oct; 5 (4): 295-9.
- Pilz, S. Henry, R. M. Snijder, M. B. van Dam, R. M. Nijpels, G. Stehouwer, C. D. Kamp, O. Tomaschitz, A. Pieber, T. R. Dekker, J. M. Vitamin D deficiency and myocardial structure and function in older men and women: the Hoorn study. J Endocrinol Invest. 2010 Oct; 33 (9): 612-7.
- Pilz, S. Marz, W. Wellnitz, B. Seelhorst, U. Fahrleitner-Pammer, A. Dimai, H. P. Boehm, B. O. Dobnig, H. Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab. 2008 Oct; 93 (10): 3927-35.
- Pilz, S. Tomaschitz, A. Drechsler, C. Dekker, J. M. Marz, W. Vitamin D deficiency and myocardial diseases. Molecular nutrition & food research. 2010 Aug; 54 (8): 1103-13.
- Rendina, D. De Filippo, G. Strazzullo, P. Should vitamin D status be assessed in patients with congestive heart failure?. Nutr Metab Cardiovasc Dis. 2010 Nov; 20 (9): 627-32.
- Rostand, S. G. Vitamin D, blood pressure, and African Americans: toward a unifying hypothesis. Clin J Am Soc Nephrol. 2010 Sep; 5 (9): 1697-703.
- Schleithoff, S. S. Zittermann, A. Tenderich, G. Berthold, H. K. Stehle, P. Koerfer, R. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2006 Apr; 83 (4): 754-9.
- Schleithoff, S. S. Zittermann, A. Tenderich, G. Berthold, H. K. Stehle, P. Koerfer, R. Combined calcium and vitamin D supplementation is not superior to calcium supplementation alone in improving disturbed bone metabolism in patients with congestive heart failure. Eur J Clin Nutr. 2008 Dec; 62 (12): 1388-94.
- Stein, E. M. Cohen, A. Freeby, M. Rogers, H. Kokolus, S. Scott, V. Mancini, D. Restaino, S. Brown, R. McMahon, D. J. Shane, E. Severe vitamin D deficiency among heart and liver transplant recipients. Clin Transplant. 2009 Nov-Dec; 23 (6): 861-5.
- Witham, M. D. Vitamin d in chronic heart failure. Current heart failure reports. 2011 Jun; 8 (2): 123-30.
- Witham, M. D. Crighton, L. J. Gillespie, N. D. Struthers, A. D. McMurdo, M. E. The effects of vitamin D supplementation on physical function and quality of life in older patients with heart failure: a randomized controlled trial. Circ Heart Fail. 2010 Mar; 3 (2): 195-201.
- Zittermann, A. Schleithoff, S. S. Frisch, S. Gotting, C. Kuhn, J. Koertke, H. Kleesiek, K. Tenderich, G. Koerfer, R. Circulating calcitriol concentrations and total mortality. Clin Chem. 2009 Jun; 55 (6): 1163-70.