Cardiomyopathy (literally “heart muscle disease”) is the failure of the heart muscle to pump enough blood. It leads to congestive heart failure (CHF), the severity of which is measured using ultrasound, such as ejection fraction, or the percentage of blood that is pumped with each beat. Often a blood test for a marker called proBNP is elevated. Common symptoms of cardiomyopathy are breathlessness, having to sit up while sleeping, and swelling of the legs. It is a lethal disease.
By far the most common cause of cardiomyopathy is extrinsic ischemic arthrosclerosis. However, there is a type of cardiomyopathy called idiopathic cardiomyopathy, which simply means the cause is unknown. For unknown reasons, the heart muscle cells are unable to contract strongly enough to pump enough blood. Idiopathic cardiomyopathy is generally a disease of younger people.
I have written about this before.
In infants and children, it is well known that vitamin D deficiency is a cause of cardiomyopathy. Doctors usually find low blood calcium together with CHF and then measure vitamin D levels to make the diagnosis of vitamin D deficient cardiomyopathy. An Egyptian researcher did a randomized controlled trial of 80 infants showing vitamin D had a dramatic treatment effect in 10-month-olds with congestive heart failure of all kinds.
What has never been done, as far as I can tell, is to study the treatment effect of vitamin D in adult idiopathic cardiomyopathy. I can’t even find a case series or a case report. That is, apparently no physician has ever thought of treating adult idiopathic cardiomyopathy with vitamin D, although vitamin D has been used to help treat idiopathic infantile cardiomyopathy.
Recently Doctor Ahmad Amin, working under Professor Maryam Ardeshiri, treated 100 consecutive CHF adult patients (55 of which had cardiomyopathy) with 50,000 IU/week of vitamin D3 for 8 weeks followed by 50,000 IU/month for 2 more months. Mean 25(OH)D increased by 17 ng/ml. The average age was only 42 so a high percentage of these patients probably had idiopathic cardiomyopathy.
They found a dramatic treatment effect of vitamin D. During 12 weeks of treatment with vitamin D, mean functional class of CHF improved significantly (P<.001). Furthermore, a significant reduction in proBNP (P<.001) occurred. Vitamin D supplementation also significantly improved the distance the patients could walk in six minutes (P<.001). CRP fell significantly (P<.001). Ejection fraction and other ultrasound measurements improved significantly (P<.001).
This was a remarkable study.
In a study from last year, Doctor Israel Gotsman and colleagues from the Heart Institute at Hadassah University Hospital in Jerusalem studied congestive heart failure (from all causes) and vitamin D in a very large group of patients. Doctor Gotsman worked under senior author Professor Dan Admon.
Gotsman I, Shauer A, Zwas DR, Hellman Y, Keren A, Lotan C, Admon D. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail. 2012 Apr;14(4):357-66.
In their study, they included patients with CHF, although they didn’t specify the cause of the CHF. However, since the average age was about 75, many of the patients likely had ischemic cardiomyopathy and not idiopathic cardiomyopathy, which is a disease of younger persons. They also included a control group.
Here is what they found:
- The 3,000 patients with CHF had lower 25(OH)D levels than the control group. No surprise here, as patients with CHF are less likely to go outside. In the CHF group, 28 percent of this population had significant vitamin D deficiency (<10 ng/ml) and only 8.8% had levels > 30 ng/ml.
- The lower the baseline 25(OH)D level, the more likely patients were to die over the next year and a half (P <0.00001). This has been shown before a number of times.
- Sixty-three percent of the 3,000 CHF patients were prescribed vitamin D (1,000 IU/day). Such supplementation was associated with a significantly reduced death rate (P<.0001). This was a big surprise.
The authors concluded,
“Vitamin D deficiency is highly prevalent in CHF patients as well as in the general population, even in a geographic location with exposure to abundant solar radiation. Vitamin D deficiency was a significant predictor of reduced survival in both CHF patients and the control groups. In addition, vitamin D supplementation was associated with increased survival in CHF patients.”
What do these and other studies tell us?
They tell us that patients with CHF, whether ischemic or idiopathic, should make sure they’re sufficient in vitamin D. And they raise the possibility that some CHF patients may see some treatment effect with 5,000 IU/day of vitamin D3 or even as high as 10,000 IU/day. It may be that some adults with idiopathic cardiomyopathy have it for the same reason some children do, vitamin D deficiency.