Vitamin D deficiency in patients with congestive heart failure: mechanisms, manifestations, and management

Recent research suggests that vitamin D may play a role in cardiovascular (CV) health. Although its exact role is still debated and is a matter of controversy, vitamin D deficiency has been linked to increased prevalence of CV risk factors and events. Factors that predispose persons with congestive heart failure (CHF) to hypovitaminosis D include nutritional deficiency, decreased skin production, reduced intestinal absorption, and hepatorenal disease. It is possible that low vitamin D can in turn aggravate CHF. The extent of deficiency can be severe enough to cause hypocalcemia, secondary hyperparathyroidism, osteomalacia, and decreased bone density. No clear data exist showing improvement in CV clinical outcomes with vitamin D replacement. Screening is advocated in most patients, although benefits of replacement are most likely to accrue in those with severe lack or with abnormalities of calcium-parathyroid-bone metabolism. According to current guidelines and research, vitamin D goals of >20 ng/ml in most patients with CHF and >30 ng/ml in those with secondary hyperparathyroidism seem to be appropriate to aim for. Further research is needed to fully unravel the association among CV risk, CHF and hypovitaminosis D, and translate this knowledge into clinically meaningful management recommendations.