Response to Letter Regarding Article, “The Effects of Vitamin D Supplementation on Physical Function and Quality of Life in Older Heart Failure Patients: A Randomized Controlled Trial”

HomeCirculation: Heart FailureVol. 3, No. 4Response to Letter Regarding Article, “The Effects of Vitamin D Supplementation on Physical Function and Quality of Life in Older Heart Failure Patients: A Randomized Controlled Trial” Free AccessReplyPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReplyPDF/EPUBResponse to Letter Regarding Article, “The Effects of Vitamin D Supplementation on Physical Function and Quality of Life in Older Heart Failure Patients: A Randomized Controlled Trial” Miles D. Witham, BM, BCh, PhD, MRCP, Linda J. Crighton, RN, Neil D. Gillespie, MB, ChB, MD, FRCP, Allan D. Struthers, MB, ChB, MD, FRCP, FESC and Marion E.T. McMurdo, BM, BCh, FRCP, CBiol, FIBiol Miles D. WithamMiles D. Witham Section of Ageing and Health Department of Clinical Pharmacology Centre for Cardiovascular and Lung Biology Division of Medicine University of Dundee Ninewells Hospital Dundee, United Kingdom (Witham, Crighton, Gillespie, Struthers, McMurdo) Search for more papers by this author , Linda J. CrightonLinda J. Crighton Section of Ageing and Health Department of Clinical Pharmacology Centre for Cardiovascular and Lung Biology Division of Medicine University of Dundee Ninewells Hospital Dundee, United Kingdom (Witham, Crighton, Gillespie, Struthers, McMurdo) Search for more papers by this author , Neil D. GillespieNeil D. Gillespie Section of Ageing and Health Department of Clinical Pharmacology Centre for Cardiovascular and Lung Biology Division of Medicine University of Dundee Ninewells Hospital Dundee, United Kingdom (Witham, Crighton, Gillespie, Struthers, McMurdo) Search for more papers by this author , Allan D. StruthersAllan D. Struthers Section of Ageing and Health Department of Clinical Pharmacology Centre for Cardiovascular and Lung Biology Division of Medicine University of Dundee Ninewells Hospital Dundee, United Kingdom (Witham, Crighton, Gillespie, Struthers, McMurdo) Search for more papers by this author and Marion E.T. McMurdoMarion E.T. McMurdo Section of Ageing and Health Department of Clinical Pharmacology Centre for Cardiovascular and Lung Biology Division of Medicine University of Dundee Ninewells Hospital Dundee, United Kingdom (Witham, Crighton, Gillespie, Struthers, McMurdo) Search for more papers by this author Originally published1 Jul 2010https://doi.org/10.1161/CIRCHEARTFAILURE.110.954677Circulation: Heart Failure. 2010;3:e25We thank Begg, Cleland, and Witte for their interest in our article and for their comments that further the debate on the role of vitamin D in vascular disease. As they correctly point out, we deliberately took a pragmatic approach to patient selection in this trial. Our patients are typical of most patients with heart failure1—they are old, have comorbid disease, and despite the relatively low frusemide doses used, they have severe functional impairment as evidenced by their low baseline 6-minute walk distances. Their heart failure treatment is not optimal; we deliberately enrolled typical older patients with heart failure, and such patients often cannot tolerate optimal therapy because of problems such as falls and drug interactions. It is for these reasons that exploring new treatments in this patient group is so important.It is certainly true that higher doses of vitamin D, taken for longer, may be required to provide optimum health outcomes. However, at the time at which this study was initiated, the dose that we used was considered relatively high, and a slightly larger dose of 2000 U/d of vitamin D3 given for 9 months also failed to provide benefit in another trial.2 Suppression of parathyroid hormone is a possible mechanism by which vitamin D supplementation might affect cardiovascular health; however, we have demonstrated improvements in endothelial function and blood pressure in a different patient group with vasculopathy using the same dose of vitamin D2, again without parathyroid hormone suppression.3 Furthermore, brain natriuretic peptide levels fell in the intervention group relative to placebo in the current study despite parathyroid hormone not being suppressed.There is much still to learn about the effects of vitamin D on vascular health, and it is certainly possible that supplementation in patients with heart failure could still reduce death and symptoms in the longer term. Such improvements do not always mean that physical function and quality of life will improve, and these key outcomes for older, frail people were not affected in our study despite a doubling of 25-hydroxyvitamin D levels from baseline. We saw no evidence of a greater increase in walking distance in those patients with the greatest increases in 25 hydroxyvitamin D levels, and we therefore doubt that further increases in dose are likely to provide additional improvement in physical function.Miles D. Witham, BM, BCh, PhD, MRCPLinda J. Crighton, RNNeil D. Gillespie, MB, ChB, MD, FRCPAllan D. Struthers, MB, ChB, MD, FRCP, FESCMarion E.T. McMurdo, BM, BCh, FRCP, CBiol, FIBiol Section of Ageing and Health Department of Clinical Pharmacology Centre for Cardiovascular and Lung Biology Division of Medicine University of Dundee Ninewells Hospital Dundee, United KingdomDisclosuresDr Witham has received grant funding for vitamin D research from the Scottish Government, Diabetes UK, Chest Heart and Stroke Scotland, Heart Research UK, and the ME Society. Professor Struthers has received grant funding for vitamin D research from the Scottish Government, Diabetes UK, and Chest Heart and Stroke Scotland. Professor McMurdo has received grant funding for vitamin D research from the Scottish Government.References1. Lien CT, Gillespie ND, Struthers AD, McMurdo ME. Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail. 2002; 4:91–98.CrossrefMedlineGoogle Scholar2. Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, 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; 83:754–759.CrossrefMedlineGoogle Scholar3. Sugden JA, Davies JI, Witham MD, Morris AD, Struthers AD. Vitamin D improves endothelial function in patients with type 2 diabetes mellitus and low vitamin D levels. Diabetes Med. 2008; 25:320–325.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Abdeen H, Rodriguez-Sanz D, Ewidea M, Al-Hamaky D, Mohamed M and Elerian A (2021) Efficacy of Vitamin D Supplementation in Addition to Aerobic Exercise Training in Obese Women with Perceived Myalgia: A Single-Blinded Randomized Controlled Clinical Trial, Nutrients, 10.3390/nu13061819, 13:6, (1819) July 2010Vol 3, Issue 4 Advertisement Article InformationMetrics © 2010 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.110.954677 Originally publishedJuly 1, 2010 PDF download Advertisement SubjectsHeart FailurePharmacologyRehabilitation