Association between Vitamin D and Heart Failure Mortality in 10,974 Hospitalized Individuals
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Clinical Outcomes
2.3. Sample Matching
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Outcomes
3.3. Subgroup-Analysis
4. Discussion
4.1. Impact of Vitamin D on HF Mortality
4.2. Mechanisms of Vitamin D for HF
4.3. Clinical Implication
4.4. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Non Matching | Matching | |||||||
---|---|---|---|---|---|---|---|---|
All | Vit.D (+) | Vit.D (−) | std.diff (%) | Vit.D (+) | Vit.D (−) | std.diff (%) | ||
Number | (n = 93,692) | (n = 5487) | (n = 88,205) | (n = 5487) | (n = 5487) | |||
Age average(years) | 79 ± 12 | 80 ± 11 | 79 ± 13 | 10.6 | 80 ± 11 | 81 ± 11 | 8.4 | |
Age(%) | 20–30 | 0.2 | 0.1 | 0.2 | −1.7 | 0.1 | 0.1 | 2.7 |
30–40 | 0.8 | 0.4 | 0.8 | −6.2 | 0.4 | 0.4 | −0.2 | |
40–50 | 2.4 | 1.4 | 2.4 | −7.8 | 1.4 | 1.1 | 2.5 | |
50–60 | 4.8 | 3.6 | 4.8 | −6.3 | 3.6 | 3.1 | 2.6 | |
60–70 | 12.1 | 10.8 | 12.2 | −4.4 | 10.8 | 9.8 | 3.3 | |
70–80 | 23.0 | 23.8 | 22.9 | 2.0 | 23.8 | 22.1 | 3.9 | |
80–90 | 39.8 | 42.4 | 39.7 | 5.5 | 42.4 | 44.2 | −3.8 | |
>90 | 17.0 | 17.6 | 17.0 | 1.7 | 17.6 | 19.3 | −4.2 | |
Male (%) | 52.2 | 33.9 | 53.4 | −40.1 | 33.9 | 31.4 | 5.3 | |
BMI | 22.7 ± 5.0 | 21.8 ± 4.1 | 22.7 ± 5.0 | −20.8 | 21.8 ± 4.1 | 21.7 ± 4.1 | 1.9 | |
Smoking | 30.2 | 21.1 | 30.8 | −22.1 | 21.1 | 18.9 | 5.7 | |
NYHA | 1 | 12.2 | 12.8 | 12.2 | 1.9 | 12.8 | 13.2 | −1.0 |
2 | 24.4 | 24.5 | 24.3 | 0.3 | 24.5 | 25.0 | −1.2 | |
3 | 32.2 | 32.1 | 32.2 | −0.2 | 32.1 | 31.8 | 0.8 | |
4 | 31.2 | 30.5 | 31.2 | −1.5 | 30.5 | 30.0 | 1.1 | |
Comorbidities (%) | ||||||||
Hypertension | 52.9 | 48.8 | 53.2 | −8.8 | 48.8 | 47.8 | 2.0 | |
Diabetes mellitus | 26.8 | 26.1 | 26.8 | −1.7 | 26.1 | 25.1 | 2.2 | |
Dyslipidemia | 18.6 | 16.2 | 18.8 | −6.7 | 16.2 | 14.9 | 3.7 | |
Osteoporosis | 3.0 | 24.5 | 1.7 | 72.1 | 24.5 | 21.2 | 7.1 | |
Hypoparathyroidism | <0.1 | 0.2 | <0.1 | 5.0 | 0.2 | <0.1 | 4.5 | |
HCM | 3.4 | 1.4 | 3.5 | −14.1 | 1.4 | 1.6 | −2.0 | |
DCM | 1.2 | 1.0 | 1.3 | −2.9 | 1.0 | 1.2 | −2.8 | |
Cardiac Amyloidosis | 0.1 | 0.1 | 0.1 | −0.8 | 0.1 | 0.1 | <0.1 | |
Cardiac Sarcoidosis | 0.3 | 0.5 | 0.3 | 3.0 | 0.5 | 0.2 | 4.5 | |
Af/AFL | 35.5 | 27.5 | 36.0 | −18.3 | 27.5 | 27.2 | 0.8 | |
AT | 0.9 | 0.6 | 0.9 | −2.9 | 0.6 | 0.7 | −0.9 | |
Stroke | 8.3 | 7.5 | 8.3 | −3.3 | 7.5 | 7.2 | 1.1 | |
MI | 10.3 | 7.9 | 10.5 | −9.1 | 7.9 | 7.2 | 2.6 | |
PVD | 3.8 | 4.8 | 3.7 | 5.1 | 4.8 | 3.9 | 4.3 | |
CKD | 14.1 | 38.6 | 12.6 | 62.5 | 38.6 | 35.3 | 6.9 | |
Liver failure | 0.1 | 0.1 | 0.1 | −0.8 | 0.1 | 0.2 | −2.7 | |
COPD | 7.4 | 6.1 | 7.5 | −5.6 | 6.1 | 5.3 | 3.6 | |
RA | 1.3 | 4.2 | 1.2 | 19.0 | 4.2 | 4.9 | −3.2 | |
Dementia | 6.2 | 6.9 | 6.2 | 3.1 | 6.9 | 7.0 | −0.4 | |
Cancer | 11.0 | 11.0 | 11.0 | 0.1 | 11.0 | 10.6 | 1.3 | |
Treatment (%) | ||||||||
Catecholamine | 12.4 | 11.3 | 12.5 | −3.8 | 11.3 | 10.6 | 2.1 | |
IABP | 1.0 | 0.9 | 1.0 | −1.1 | 0.9 | 1.1 | −1.7 | |
PCPS | 0.1 | 0.0 | 0.2 | −3.6 | 0.0 | 0.1 | −0.5 | |
Artificial Ventilation | 21.3 | 21.1 | 21.3 | −0.5 | 21.1 | 20.8 | 0.7 | |
Hemodialysis | 4.6 | 29.5 | 3.1 | 76.8 | 29.5 | 28.3 | 2.6 | |
PCI | 4.9 | 5.2 | 4.9 | 1.6 | 5.2 | 5.1 | 0.7 | |
Drug (%) | ||||||||
ACE-i/ARB | 19.7 | 19.4 | 19.8 | −0.8 | 19.4 | 21.0 | −3.9 | |
βblocker | 9.1 | 8.0 | 9.2 | −4.1 | 8.0 | 8.6 | −1.9 | |
Loop diuretic | 19.4 | 18.4 | 19.4 | −2.6 | 18.4 | 20.3 | −4.8 | |
K-sparing diuretic | 10.1 | 7.4 | 10.3 | −10.3 | 7.4 | 8.4 | −3.7 | |
Statin | 13.1 | 13.5 | 13.0 | 1.2 | 13.5 | 13.7 | −0.7 | |
Hospital length (days) | 18 (12–28) | 19 (12–31) | 17 (12–27) | 13.1 | 19 (12–31) | 18 (11–30) | 14.9 |
Non Matching | Matching | |||||||
---|---|---|---|---|---|---|---|---|
In-Hospital Mortality | Vit.D (+) | Vit.D (−) | OR (95%CI) | p-Value | Vit.D (+) | Vit.D (−) | OR (95%CI) | p-Value |
Total (%) | 357 (6.5) | 7256 (8.2) | 0.79 (0.71–0.88) | <0.0001 | 357 (6.5) | 515 (9.4) | 0.67 (0.58–0.77) | <0.0001 |
7 days (%) | 48 (0.9) | 1761 (2.0) | 0.44 (0.33–0.58) | <0.0001 | 48 (0.9) | 138 (2.5) | 0.34 (0.25–0.48) | <0.0001 |
30 days (%) | 207 (3.8) | 5171 (5.9) | 0.64 (0.55–0.73) | <0.0001 | 207 (3.8) | 358 (6.5) | 0.56 (0.47–0.67) | <0.0001 |
A: In all patients. See abbreviations in Table 1. | ||||
All | ||||
OR | Lower | Higher | p | |
Vit.D | 0.63 | 0.49 | 0.81 | 0.0003 |
Age | 1.06 | 1.05 | 1.08 | <0.0001 |
BMI | 0.93 | 0.90 | 0.96 | <0.0001 |
NYHA | 1.18 | 1.04 | 1.33 | 0.0070 |
Male | 1.00 | 0.74 | 1.35 | 0.9884 |
Smoking | 0.93 | 0.67 | 1.31 | 0.6867 |
HT | 0.39 | 0.30 | 0.51 | <0.0001 |
DM | 0.80 | 0.60 | 1.07 | 0.1398 |
DL | 0.83 | 0.57 | 1.22 | 0.3445 |
MI | 1.17 | 0.76 | 1.80 | 0.4721 |
PVD | 1.88 | 1.19 | 2.96 | 0.0064 |
Stroke | 0.96 | 0.62 | 1.50 | 0.8659 |
Dementia | 1.21 | 0.78 | 1.87 | 0.4000 |
COPD | 0.95 | 0.56 | 1.59 | 0.8370 |
RA | 1.10 | 0.65 | 1.89 | 0.7187 |
CKD | 1.65 | 1.19 | 2.30 | 0.0030 |
Cancer | 0.84 | 0.57 | 1.24 | 0.3764 |
Hemodialysis | 0.84 | 0.58 | 1.22 | 0.3669 |
Artificial Ventilation | 2.55 | 1.95 | 3.33 | <0.0001 |
PCI | 0.22 | 0.10 | 0.47 | <0.0001 |
IABP | 1.04 | 0.44 | 2.43 | 0.9355 |
Catecholamines | 4.59 | 3.50 | 6.02 | <0.0001 |
Osteoporosis | 0.76 | 0.48 | 1.19 | 0.2331 |
HCM | 0.61 | 0.18 | 2.09 | 0.4338 |
Sarcoidosis | 2.60 | 0.55 | 12.18 | 0.2253 |
Af/AFL | 0.68 | 0.51 | 0.92 | 0.0107 |
B: In patients with vitamin D supplementation. See abbreviations in Table 1. | ||||
Vitamin D (+) | ||||
OR | Lower | Higher | p | |
Age | 1.07 | 1.04 | 1.09 | <0.0001 |
BMI | 0.97 | 0.92 | 1.02 | 0.2186 |
NYHA | 1.22 | 1.01 | 1.48 | 0.0379 |
Male | 0.62 | 0.37 | 1.02 | 0.0589 |
Smoking | 1.10 | 0.64 | 1.87 | 0.7396 |
HT | 0.33 | 0.22 | 0.52 | <0.0001 |
DM | 0.70 | 0.44 | 1.11 | 0.1257 |
DL | 1.11 | 0.64 | 1.90 | 0.7187 |
MI | 1.36 | 0.71 | 2.59 | 0.3519 |
PVD | 2.24 | 1.18 | 4.27 | 0.0138 |
Stroke | 1.25 | 0.66 | 2.37 | 0.4844 |
Dementia | 1.17 | 0.59 | 2.31 | 0.6536 |
COPD | 0.86 | 0.38 | 1.94 | 0.7122 |
RA | 0.80 | 0.30 | 2.12 | 0.6558 |
CKD | 1.68 | 0.95 | 2.99 | 0.0746 |
Cancer | 1.09 | 0.60 | 1.98 | 0.7663 |
Hemodialysis | 0.98 | 0.52 | 1.85 | 0.9510 |
Artificial Ventilation | 2.18 | 1.44 | 3.31 | 0.0003 |
PCI | 0.19 | 0.06 | 0.64 | 0.0075 |
IABP | 1.34 | 0.40 | 4.49 | 0.6352 |
Catecholamines | 4.91 | 3.24 | 7.43 | <0.0001 |
Osteoporosis | 0.61 | 0.36 | 1.04 | 0.0707 |
HCM | 1.57 | 0.34 | 7.23 | 0.5659 |
Sarcoidosis | 2.14 | 0.26 | 17.31 | 0.4763 |
Af/AFL | 0.66 | 0.41 | 1.06 | 0.0822 |
C: In patients without vitamin D supplementation. See abbreviations in Table 1. | ||||
Vitamin D (−) | ||||
OR | Lower | Higher | p | |
Age | 1.07 | 1.04 | 1.09 | <0.0001 |
BMI | 0.91 | 0.87 | 0.95 | <0.0001 |
NYHA | 1.14 | 0.97 | 1.33 | 0.1111 |
Male | 1.36 | 0.93 | 2.01 | 0.1153 |
Smoking | 0.83 | 0.54 | 1.30 | 0.4209 |
HT | 0.43 | 0.30 | 0.60 | <0.0001 |
DM | 0.87 | 0.59 | 1.28 | 0.4857 |
DL | 0.64 | 0.37 | 1.10 | 0.1087 |
MI | 1.06 | 0.59 | 1.90 | 0.8573 |
PVD | 1.53 | 0.79 | 2.95 | 0.2038 |
Stroke | 0.77 | 0.40 | 1.45 | 0.4106 |
Dementia | 1.20 | 0.67 | 2.15 | 0.5442 |
COPD | 1.01 | 0.51 | 1.99 | 0.9816 |
RA | 1.19 | 0.61 | 2.31 | 0.6059 |
CKD | 1.55 | 1.02 | 2.36 | 0.0386 |
Cancer | 0.75 | 0.45 | 1.26 | 0.2757 |
Hemodialysis | 0.78 | 0.48 | 1.26 | 0.3036 |
Artificial Ventilation | 3.03 | 2.12 | 4.32 | <0.0001 |
PCI | 0.25 | 0.09 | 0.65 | 0.0048 |
IABP | 0.74 | 0.21 | 2.59 | 0.6374 |
Catecholamines | 4.72 | 3.26 | 6.82 | <0.0001 |
Osteoporosis | 1.85 | 0.76 | 4.50 | 0.1746 |
HCM | 0.24 | 0.03 | 2.05 | 0.1939 |
Sarcoidosis | 3.58 | 0.35 | 36.60 | 0.2815 |
Af/AFL | 0.70 | 0.48 | 1.02 | 0.0632 |
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Kusunose, K.; Okushi, Y.; Okayama, Y.; Zheng, R.; Abe, M.; Nakai, M.; Sumita, Y.; Ise, T.; Tobiume, T.; Yamaguchi, K.; et al. Association between Vitamin D and Heart Failure Mortality in 10,974 Hospitalized Individuals. Nutrients 2021, 13, 335. https://doi.org/10.3390/nu13020335
Kusunose K, Okushi Y, Okayama Y, Zheng R, Abe M, Nakai M, Sumita Y, Ise T, Tobiume T, Yamaguchi K, et al. Association between Vitamin D and Heart Failure Mortality in 10,974 Hospitalized Individuals. Nutrients. 2021; 13(2):335. https://doi.org/10.3390/nu13020335
Chicago/Turabian StyleKusunose, Kenya, Yuichiro Okushi, Yoshihiro Okayama, Robert Zheng, Miho Abe, Michikazu Nakai, Yoko Sumita, Takayuki Ise, Takeshi Tobiume, Koji Yamaguchi, and et al. 2021. "Association between Vitamin D and Heart Failure Mortality in 10,974 Hospitalized Individuals" Nutrients 13, no. 2: 335. https://doi.org/10.3390/nu13020335