Introduction: Vitamin D deficiency has been associated with the progression of heart failure (HF) and Vitamin D supplementation may have protective effects in patients with HF. However, little is known on the predictive value of circulating Vitamin D levels on HF risk.
Hypothesis: Low serum Vitamin D levels are associated with incident HF in a large prospective cohort of Italian adults.
Methods: We analyzed 18,689 (48.4% men, age ≥35 years) HF-free individuals randomly recruited from the general population of the Moli-sani study, for whom complete data on HF and serum Vitamin D were available. Vitamin D was measured on serum by an immunoassay in the central laboratory of European BiomarCaRE project (Abbott Architect 25-OH Vitamin D, Wiesbaden, Germany). The cohort was followed up for a median of 4.2 years (80,849 person-years). Baseline serum Vitamin D was categorized in deficient/insufficient, hypovitaminosis, and normal (Table). Incident cases of HF were identified by linkage with the regional archive of hospital discharges. Hazard ratios (HRs) were calculated using Cox-proportional hazard models.
Results: Subjects with normal, hypo or insufficient levels of Vitamin D were 12.2%, 79.6% and 8.2%, respectively. We identified 412 incident cases of HF. The incidence of HF was 1.1%, 2.2% and 3.9%, respectively in subjects with normal, hypo and insufficient levels of Vitamin D. After a multivariable analysis, considering a large panel of potential covariates, individuals with deficient/insufficient levels of serum Vitamin D showed a higher risk of developing HF (HR: 1.78, 95% CI: 1.07-2.97) than those with normal levels. Further adjustment for C-Reactive Protein did not modify the association (Table).
Conclusions: Deficiency of Vitamin D is associated with a significantly higher risk of HF in a general adult population. This association was not explained by an inflammatory marker such as C-Reactive Protein.