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Suboptimal Vitamin D in PAH: Prevalence, Optimizing Levels with Cholecalciferol

T. Stamatakos

J. Gilkison

A. Lanich

B. Kinder

Jean Elwing

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Conference: 2010 International PHA Conference and Scientific Sessions

Release Date: 06.24.2010

Presentation Type: Abstracts

Stamatakos T, Gilkison J, Lanich A, Kinder B, Elwing J. 
University of Cincinnati Physicians, Pulmonary Hypertension Program, Cincinnati, OH, USA

BACKGROUNDVitamin D deficiency is becoming recognized as a worldwide epidemic. Most experts define 25-hydroxyvitamin D [25(OH)D] level (the functional indicator for Vitamin D status) of less than 20 ng/ mL as deficient and a level of 20 to 29 ng/mL as insufficient. A vitamin D receptor is found on most cells and tissues in our body and has spurred interest in the role of vitamin D in chronic illnesses, including common cancers, autoimmune diseases, infectious diseases, hypertension and cardiovascular disease. Obtaining therapeutic vitamin D levels can be a challenge for care providers since most experts agree that the recommended daily intake of vitamin D is set too low. Currently vitamin D deficiency in pulmonary arterial hypertension (PAH) is not well described. In the UC PAH clinic, we noticed that many patients had sub-therapeutic 25(OH)D levels. This prompted a systematic evaluation of Vitamin D levels in our patient population.

METHODSA retrospective cohort of PAH patients (WHO group 1) followed in an academic Pulmonary Hypertension Program from January 2009 to present was performed. Subject characteristics were recorded, including age, gender and race. As a quality improvement initiative cholecalciferol (vitamin D3) treatment of 800 to 1,000 IU daily in addition to a multivitamin was recommended to our patients with suboptimal levels of 25(OH)D < 30 ng/mL. Patients were contacted and educated on vitamin D & cholecalciferol supplementation by a registered dietitian. Ten to fifteen minutes of sun exposure several times a week was also encouraged. Repeat 25(OH)D levels were obtained approximately 4 months after initiating therapy to ensure adequate supplementation.

RESULTSOf 90 PAH patients who underwent serum 25(OH)D level assessment the mean level was 19.9 ng/ mL, 82% had levels less than 30 ng/mL pre-treatment. Fifty one were deficient (56%) and 24 were insufficient (26%). There was no significant difference in vitamin D levels based on age and gender (p= 0.9 and p= 0.8). African-Americans had a significantly lower mean than Caucasians (16 ng/mL vs 23 ng/mL, p= 0.013). Of the suboptimal group the mean baseline 25(OH)D was 15.4 ng/mL. Forty patients had follow up vitamin D levels drawn after treatment of chronic vitamin D3 supplementation, the levels increased by an average of 14.9 ng/mL to a new mean of 29.3 ng/mL. Fifty five percent remained below goal of 30 ng/mL.

CONCLUSIONSSuboptimal vitamin D is common among PAH patients. More than half of the patients were unable to achieve a desirable level of serum 25(OH)D over a four month period of daily cholecalciferol supplementation. Achieving 25(OH)D concentrations of 30 ng/mL or higher in our suboptimal group may require a more aggressive dosing regimen with close monitoring. Further research is needed to determine adequate repletion therapy to achieve & maintain normal serum vitamin D concentrations.