Mghaieth Fathia, Hammami Bessem, Jeddou Syrine Ben, Boudiche Selim, Halima Manel Ben, Bensassi Jihen, Soula Amine, Taieb Sameh Hadj, Feki Moncef, Mourali Mohamed S
University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.
Rabta Hospital, Service of Cardiology, 1007 Jebbari, Tunis, Tunisia.
Glob Cardiol Sci Pract. 2025 Feb 28;2025(1):e202507. doi: 10.21542/gcsp.2025.7.
Hypovitaminosis D and hyperreninemia are associated with poor prognosis in patients with chronic heart failure (CHF). We aimed to evaluate the effect of vitamin D (VitD) supplementation on the renin-angiotensin-aldosterone system (RAAS) in CHF patients with reduced left ventricular ejection fraction (HFrEF). A double-blind placebo-controlled randomized clinical trial was conducted in HFrEF patients. Patients were randomized to receive two doses of 200,000 IU VitD3 (VitD group) or saline solution (placebo group) at a two-week interval. Plasma 25-hydroxyvitamin D and renin concentrations were assessed at baseline and one month after the first dose. The primary outcome was plasma renin change. The study was registered at the Pan African Clinical Trials Registry as PACTR201908774181973. Forty patients in each group completed the trial. At baseline, hypovitaminosis D and hyperreninemia were found in 85% and 77.5% of patients, respectively, with no differences between VitD and placebo groups. VitD supplementation resulted in an increase in 25-hydroxyvitamin D in the VitD group, only. In parallel, plasma renin decreased in the VitD group [renin change: median (25th percentile; 75th percentile), -34.9 (-110; -7.1)], but did not change in the placebo group [1.35 (-1.2; 8.8)]. No significant changes were found for clinical, echocardiographic, and other biochemical parameters in both groups. A mega-dose of vitamin D resulted in middle-term RAAS suppression but didn't affect cardiac function and clinical features in HFrEF patients. Further research with longer follow-ups is needed to evaluate whether persistent adequate VitD status results in long-term RAAS suppression and cardiac function improvement.
维生素D缺乏和高肾素血症与慢性心力衰竭（CHF）患者的不良预后相关。我们旨在评估补充维生素D（VitD）对左心室射血分数降低的CHF患者（HFrEF）肾素-血管紧张素-醛固酮系统（RAAS）的影响。在HFrEF患者中进行了一项双盲安慰剂对照随机临床试验。患者被随机分为每两周接受两剂200,000 IU VitD3（VitD组）或生理盐水溶液（安慰剂组）。在基线和首剂后1个月评估血浆25-羟维生素D和肾素浓度。主要结局是血浆肾素变化。该研究在泛非临床试验注册中心注册为PACTR201908774181973。每组40例患者完成试验。基线时，分别在85%和77.5%的患者中发现维生素D缺乏和高肾素血症，VitD组和安慰剂组之间无差异。仅VitD组补充VitD导致25-羟维生素D增加。同时，VitD组血浆肾素降低[肾素变化：中位数（第25百分位数；第75百分位数），-34.9（-110；-7.1）]，而安慰剂组未变化[1.35（-1.2；8.8）]。两组的临床、超声心动图和其他生化参数均未发现显著变化。大剂量维生素D导致中期RAAS抑制，但不影响HFrEF患者的心脏功能和临床特征。需要进行更长随访时间的进一步研究，以评估持续充足的VitD状态是否会导致长期RAAS抑制和心脏功能改善。
