Prof.dr. Sekib Sokolovic,EHS, F.E.S.C. - PowerPoint PPT Presentation

Title: Prof.dr. Sekib Sokolovic,EHS, F.E.S.C.


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Meeting of the Balkan Excellent Centers Vitamin
D and Arterial Stiffnes

• Prof.dr. Sekib Sokolovic,EHS, F.E.S.C.
• University Clinical Center Sarajevo and Medical
  Faculty
• Cardiology Clinic
• Postintensive and Postsurgery Cardiology Care
  Department
• Sarajevo, Bosnia and Herzegovina

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Abstract

• The correlation between the arterial stiffness
  and Vitamin D has been examined in a certain
  studies. Measurement of the arterial stiffness
  has been recommended in a new ESC/ESH guidelines
  for the arterial hypertension. In order to
  evaluate arterial stiffness, the measurement of
  aortic pulse wave velocity, (APWV) and
  Augmentation Index (AI) was performed using
  Agedio Arteriograph. The estimation of
  cardiovascular risk factors was performed in all
  88 subjects and two group were formed. Vitamin D
  has been evaluated in a hypertensive and
  normotensive patients. The open outpatient
  controlled prospective study has been designed.
  Preliminary results showed the significant
  increase in PWV with average values of 10, 1
  m/sec in hypertensive patients compared to 7, 7
  m/sec in normotensive ones. The Augmentation
  index was borderline at 32, 75, ranging from
  24-56 vs 27, 25. Average blood pressure was
  172/109,5mmHg, compared to 128/82 mmHg and heart
  rate was 70b/min in average vs. 89,5b/m. Vitamin
  D average level in hypertensives was 16,9ng/ml
  compared to 28,0 ng/ml in normotensive ones.
• The arterial stiffness has been proved
  significant in hypertensive patients with vitamin
  D deficiency.

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NORMAL
DEFICINECY
Vitamin D deficitEUROPEAN PROBLEM of PUBLIC
HEALTH
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RAS and VIT D

• Decreased renin and angiotensin II levels were
  observed in several, but not all, studies that
  examined the activity of the RAAS after treatment
  with vitamin D, 1,25(OH)2D or active vitamin D
  analogs
• Sugden, J. A., et al,Vitamin D improves
  endothelial function in patients with type 2
  diabetes mellitus and low vitamin D
  levels. Diabet. Med. 25, 320-325 (2008).
• Park, C. W. et al. Intravenous calcitriol
  regresses myocardial hypertrophy in hemodialysis
  patients with secondary hyperparathyroidism. Am.
  J.Kidney Dis. 33, 73-81 (1999).
• Lind, L., et al, Reduction of blood pressure
  during long-term treatment with active vitamin D
  (alphacalcidol) is dependent on plasma renin
  activity and calcium status. A double-blind,
  placebo-controlled study. Am. J. Hypertens. 2,
  20-25 (1989).
• Kimura, Y. et al. Effectiveness of
  1,25-dihydroxyvitamin D supplementation on blood
  pressure reduction in a pseudohypoparathyroidism
  patient with high renin activity.Intern. Med. 38,
  31-35 (1999).
• Resnick, L. M. et al. Does 1,25 dihydroxyvitamin
  D (1.25D) cause low renin hypertension?
  abstract Hypertension 6, 792 (1984).
• Freundlich, M. et al. Suppression of
  renin-angiotensin gene expression in the kidney
  by paracalcitol. Kidney Int. 74, 1394-1402
  (2008).

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Health Problem Prev / Treat Reduction    Notes
Hypertension T 149 to 142 RCT, mm Hg avrg., 3000 IU Am J Hypertens. 2012
Cardiovascular T 32 Death after heart failure, 1000 IU Eur J Heart Fail. 2012
Diabetes T1 P 85 12000 kids, 2000 IU Lancet, 2001
Diabetes T 2 T 62 RCT, HOMA 24 reduction, 4000 IU FASEB, 2010
Back Pain T 95 5000/10000 IU, depending on BW Spine, 2003
Influenza P 90 RCT, 2000 IU Exp Biology and Med,,2010
Falls P 19 RCT, 1000 IU
Hip Fractures P 30 Meta-analysis, at least 800 IU N Engl J Med. 2012
Rickets P 98 400 IU Arch Dis Child. 2007
Raynaud's Syndrome T 40 RCT, visual scale, 20000 IU avg Rheumatol Int. 2012
Menstrual pain P 76 RCT, 7000 IU avg Arch Intern Med. 2012
Pregnancy risks P 50 RCT, 4000 IU J Bone Miner Res, 2011
C-section, unplanned P 50 RCT, 4000 IU, small study J Bone Miner Res. 2011
Low birth weight P 60 Meta-analysis 1000 IU of D2 Paediatr Perin Epid, 2012
TB P 60 RCT 800 IU Am J Clin Nutr, 2012
Breast Cancer P 16 Meta-analysis, every 1ng/ml incr. PLoS One, 2012
Rheumatoid Arthritis pain T 40 RCT 500 IU, added to prescription Int J Rheum Dis. 2011
Cystic Fibrosis T 75 RCT pilot 4X fewer deaths 250,000 IU Dermato-Endocrin, 2012
Chronic Kidney T 90 to 70 RCT, 3500 IU, PTH avg Am J Clin Nutr. 2012
Respiratory Tract Infection P 63 RCT 4000 IU 1 year J Pharm Pharmacother 2012
Lupus T No flares Loading then 100,000 IU monthly Arthritis Res Therapy 2012
Sickle Cell T Less pain RCT up to 100,000 IU/week Brit J Haemat, 2012
Leg ulcer healing T 4X faster RCT, 50,0000 IU/week, small study Rev Col Bras Cir, 2012

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Antihypertensive effects of vit D

• Suppression of Renin and PTH
• Renoprotective, anti-inflammatory and
  vasculoprotective properties
• Low Vit D Independent risk factor for incident
  HTA
• Pilz S1, Tomaschitz A. Expert Rev Cardiovasc
  Ther. 2010 Nov8(11)1599-608. doi
  10.1586/erc.10.142.

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• Arterial Stiffness and Vitamin D Levels the
  Baltimore Longitudinal Study of Aging
• Francesco Giallauria et al,  2012
• To test that 25-hydroxyvitamin D (25-OH D) is an
  independent cross-sectional correlate of central
  arterial stiffness in a normative aging
• Vit D levels are inversely associated with
  increased arterial stiffness irrespective of
  traditional risk factor burden 

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Diabetes Care 2015

• Pranati Jha, et al Low Serum Vitamin D Levels
  Are Associated With Increased Arterial Stiffness
  in Youth With Type 2 Diabetes
• 25OHD is inversely associated with arterial
  stiffness in lean adolescents and obese
  adolescents with T2DM but not in obese
  normoglycemic adolescents
•  The mean 25OHD levels were 21.27, 14.29, and
  14.13 ng/mL in lean individuals, obese
  individuals, and obese individuals with T2DM (P lt
  0.01)
• 3 ng/mL ?in 25OHD was associated with Aix of 1

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Diabetes Res Clin Pract. 2012

• Serum 25-hydroxyvitamin D concentration and
  arterial stiffness among type 2 diabetes
• Lee JI1, et al,
• Prevalence of vit D deficiency 85.9.
• Lower vitamin D... more increased PWV 
• Vitamin D deficiency is common in type 2
  diabetes, and significantly associated with
  increased arterial stiffness in DM

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PILOT STUDY Vit.n D status of adults Bosnia
gt30 ng/mL
lt20 ng/mL
20-30 ng/mL
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Average value of serum 25(OH)D

• Minimal value 3.0
  ng/mL
• Maximum of 70.0
  ng/mL.
• Median vitamin D level 16.9 ng/mL
• Interquartile range 9.6-26.2 ng/mL
  (Kolmogorov-Smirnovtest) p0,000)
• Severe VD deff (lt10 ng/mL) 25.9
• Deff of VD (10-20 ng/mL) 34.7
• Insuff. of VD (20-30 ng/mL) 21.4
• Sufficient VitD gt30ng/ml 18.0

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3-D ECHO
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Preliminary results

• HYPERTENSIVE PTS
• 88 pts with decreased VIT D
• Significant increase in PWV Average of 10,1
  m/sec
• Augmentation index borderline32,75,(24-56)
• Average BP172/109,5mmHg, HR70b/min
• NORMOTENSIVE PTS
• Average PWV7,75 m/sec,
• Augmentation Index Average of 27,25.
• Average BP 128/82,75mmHg, HR 89,5b/min.

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VITAMIN D/Ca score/Arterial Stiffness Case report

• Female 65 y/old
• Vitamin D 28
• Calcium score LAD 17, Cx 19
• LAD Stenosis less than 50
• PWV 8,5 m/sec
• Augm. Index 20
• SV 3,8L/min
• RR 102/81, puls 88/min
• Vascular age 3 years younger

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CONCLUSION

• The arterial stiffness has been proved
  significant in hypertensive patients with
  defficient vitamin D level