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Vitamin D insufficiency in congestive heart failure: Why and what to do about it?

Heart Failure Reviews volume 11, pages 25–33 (2006)Cite this article

Abstract

This article gives an overview of the current knowledge on vitamin D status in patients with congestive heart failure (CHF). A serum 25-hydroxyvitamin D level below 50 nmol/l (20 ng/ml) is generally regarded as insufficient. Available data indicate that the majority of CHF patients have 25-hydroxyvitamin D levels in the insufficiency range. Skin synthesis of vitamin D after solar ultraviolet B exposure is the most important vitamin D source for humans. However, CHF patients have relatively low outdoor activities. Consequently, a disease-related sedentary lifestyle is an important cause for the insufficient vitamin D status in CHF patients. There is also evidence from a recently performed case-controlled study that indicators of ultraviolet B exposure are already reduced in CHF patients during childhood, adolescence, and early adulthood compared to healthy controls. We present results indicating that an insufficient vitamin D status may contribute to the etiology/pathogenesis of CHF. Data include a vitamin D-mediated reduction of elevated blood pressure as well as a vitamin D-mediated prevention of enhanced parathyroid hormone levels, a pathophysiological state that contributes to cardiovascular disease. Based on population attributable risks, hypertension and cardiovascular disease have a high impact, accounting for the majority of CHF events.

Theoretically, vitamin D status can be improved by adequate skin synthesis of vitamin D and/or adequate oral vitamin D intake. At present, daily oral intake of 50–100μ g vitamin D seems to be the most effective way to improve vitamin D status in CHF patients.

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References

  1. Hobbs FD, The scale of heart failure: diagnosis and management issues for primary care. Heart 1999;82 Suppl 4:IV8–IV10.

    Google Scholar 

  2. Bleumink GS, Knetsch AM, Sturkenboom MC, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J 2004;25:1614–19.

    PubMed  Article  Google Scholar 

  3. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002;347:1397–1402.

    PubMed  Article  Google Scholar 

  4. Zittermann A, Vitamin D in preventive medicine – are we ignoring the evidence? Br J Nutr 89;2003:552–72.

    PubMed  Article  CAS  Google Scholar 

  5. Zittermann A, Schleithoff SS, Koerfer R, Putting cardiovascular disease and vitamin D insufficiency into perspective. Br J Nutr 94;2005:483–92.

    PubMed  Article  CAS  Google Scholar 

  6. Thomasset M, Parkes CO, Cuisinier-Gleizes P, Rat calcium-binding proteins: distribution, development, and vitamin D dependence. Am J Physiol 243;1982:E483–8.

    PubMed  CAS  Google Scholar 

  7. Simpson RU, Weishaar RE, Involvement of 1,25-dihydroxyvitamin D3 in regulating myocardial calcium metabolism: physiological and pathological actions. Cell Calcium 1988;9:285–92.

    PubMed  Article  CAS  Google Scholar 

  8. De Boland AR, Boland RL, Non-genomic signal transduction pathway of vitamin D in muscle. Cell Signal 1994;6:717–24.

    PubMed  Article  CAS  Google Scholar 

  9. Lips P, Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 22;2001:477–501.

    PubMed  Article  CAS  Google Scholar 

  10. Lips P, Hackeng WHL, Jongen MJM, van Ginkel FC, Netelenbos JC, Seasonal variation in serum concentrations of parathyroid hormone in elderly people. J Clin Endocrinol Metab. 57;1983:204–6.

    PubMed  CAS  Article  Google Scholar 

  11. Lips P, How to define normal values for serum concentrations of 25-hydroxyvitaminD? An overview. In: Vitamin D 2nd edition. Edited by D Feldman, J W Pike, FH Glorieux. Amsterdam. Elsevier Academic Press, Amsterdam, 2005:1019–928.

    Google Scholar 

  12. Vieth R, Ladak Y, Walfish .PG, Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88;2003:185–91.

    PubMed  Article  CAS  Google Scholar 

  13. Gomez-Alonso C, Naves-Diaz ML, Feernandez-Martin JL, Diaz-Lopez JB, Fernandez-Coto MT, Cannata-Andia JB, Vitamin D status and secondary hyperparathyroidism: The importance of 25-hydroxyvitamin D cut-off levels. Kidney International 85;2003 Suppl:44–8.

    Google Scholar 

  14. Christ E, Linka A, Junga G, Odermatt M, Steinert H, Kiowski W, Schmid C, Bone density and laboratory parameters of bone metabolism in patients with terminal heart disease. Schweiz Med Woschschr 126;1996:1553–9 [In German].

  15. Shane E, Mancini D, Aaronson K, Silverberg SJ, Seibel MJ, Addesso V, McMahon DJ, Bone mass, vitamin D deficiency, and hyperparathyroidism in congestive heart failure. Am J Med 103;1997:197–207.

    PubMed  Article  CAS  Google Scholar 

  16. Garcia Delgado I, Gil-Fraguas L, Robles E, Martinez G, Hawkins F, Clinical factors associated with bone loss previuos to cardiac transplantation. Med Clin 114;2000:761–4 [In Spanish].

  17. Zittermann A, Schleithoff SS, Tenderich G, Berthold HK, Körfer R, Stehle P: Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 41;2003:105–12.

    PubMed  Article  CAS  Google Scholar 

  18. Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R: Vitamin D Supplementation Improves Cytokine Profile In Patients With Congestive Heart Failure: A Double-Blind, Randomized, Placebo-Controlled Trial. Am J Clin Nutr 83; 2006:754–9.

    PubMed  CAS  Google Scholar 

  19. McKenna M., Differences in vitamin D status between countries in young adults and elderly. Amer J Med 93;1992:69–77.

    PubMed  Article  CAS  Google Scholar 

  20. Kriegsman DM, Deeg DJ, van Eijk JT, Penninx BW, Boeke AJ, Do disease characteristics add to the explanation of mobility limitations in patients with different chronic diseases? A study in The Netherlands. J Epidemiol Community Health 51;1997:676–85.

    PubMed  CAS  Article  Google Scholar 

  21. Albanese MC, Plewka M, Gregori D, Fresco C, Avon G, Calandro D, Grassi L, Rossi P, Udina P, Bulfoni A, Colle R, Cuzzato AL, Fioretti PM, Use of medical resources and qualità of life of patients with chronic heart failure: A prospective survey in a large Italian community hospital. Eur J Heart Fail 1;1999:411–17.

    PubMed  Article  CAS  Google Scholar 

  22. Zittermann A, Sabatschus O, Jantzen S, Platen P, Danz A, Dimitriou T, Scheld K, Klein K, Stehle P: Exercise-trained young men have higher calcium absorption rates and plasma calcitriol levels in comparison to age-matched sedentary controls. Calcif Tissue Int 67;2000:215–19.

    PubMed  Article  CAS  Google Scholar 

  23. MacLaughlin J, Holick MF, Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76;1985:1536–8.

    PubMed  CAS  Article  Google Scholar 

  24. Nisho K, Mukae S, Aoki S, Itoh S, Konno N, Ozawa K, Satoh R, Katagiri T, Congestive heart failure is associated with the rate of bone loss. J Intern Med 253;2003:439–46.

    Article  Google Scholar 

  25. Bouillon RA, Auwerx JH, Lissens WD, Pelemans WK, Vitamin D status in the elderly: seasonal substrate deficiency causes 1,25-dihydroxycholecalciferol deficiency. Am J Clin Nutr 45;1987:755–63.

    PubMed  CAS  Google Scholar 

  26. Zittermann A, Scheld K, Stehle P, Seasonal variations in vitamin D status and calcium absorption do not influence bone turnover in young women. Eur J Clin Nutr 52;1998:501–6.

    PubMed  Article  CAS  Google Scholar 

  27. Cohen et N, Gorelik O, Almoznino-Sarafian D, Tourovski Y, Weissgarten J, Chachashvily S, Shteinshnaider M, Modai D, Renal dysfunction in congestive heart failure, pathophysiological and prognostic significance. Clin Nephrol 61;2004:177–84.

    Google Scholar 

  28. Silverberg D, Wexler D, Blum M, Schwartz D, Iana A, The association between congestive heart failure and chronic renal disease. Curr Opin Nephrol Hypertens. 13;2004:163–70.

    PubMed  CAS  Google Scholar 

  29. Haug CJ, Aukrust P, Haug E, Morkrid L, Muller F, Froland SS, Severe deficiency of 1,25-dihydroxyvitamin D3 in human immunodeficiency virus infection: association with immunological hyperactivity and only minor changes in calcium homeostasis. J Clin Endocrinol Metab 1998;83:3832–8.

    PubMed  Article  CAS  Google Scholar 

  30. Kannel WB, Incidence and epidemiology of heart failure. Heart Fail Rev 2000;5:167–73.

    PubMed  Article  CAS  Google Scholar 

  31. Li YC, Vitamin D regulation of the renin-angiotensin system. J Cell Biochem. 88;2003:327–31.

    PubMed  Article  CAS  Google Scholar 

  32. Kimura Y, Kawamura M, Owada M, Oshima T, Murooka M, Fujiwara T, Hiramori K, Effectiveness of 1,25-dihydroxyvitamin D supplementation on blood pressure reduction in a pseudohypoparathyroidism patient with high renin activity. Intern Med. 38;1999:31–5.

    PubMed  CAS  Google Scholar 

  33. Park CW, Oh YS, Shin YS, Kim CM, Kim SY, Choi EJ, Chang YS, Bank BK, Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis. 33;1999:73–81.

    PubMed  CAS  Google Scholar 

  34. Krause R, Buhring M, Hopfenmuller W, Holick MF, Sharma AM, Ultraviolet B and blood pressure. Lancet 352;1998:709–10.

    PubMed  Article  CAS  Google Scholar 

  35. Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C, Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab 86;2001:1633–7.

    PubMed  Article  CAS  Google Scholar 

  36. Drueke TB, McCarron DA, Paricalcitol as compared with calcitriol in patients undergoing hemodialysis. N Engl J Med. 349;2003:496–9.

    PubMed  Article  Google Scholar 

  37. Rostand SG, Drueke TB, Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int 56;1999:383–92.

    PubMed  Article  CAS  Google Scholar 

  38. Shoji T, Shinohara K, Kimoto E, Emoto M, Tahara H, Koyama H, Inaba M, Fukumoto S, Ishimura E, Miki T, Tabata T, Nishizawa Y, Lower risk for cardiovascular mortality in oral 1alpha-hydroxy vitamin D3 users in a haemodialysis population. Nephrol Dial Transplant 19;2004:179–84.

    PubMed  Article  CAS  Google Scholar 

  39. Teng M, Wolf M, Ofsthun N, Lazarus JM, Hernan MA, Camaergo CA, Thadhani R, Activated injectable vitamin D and hemodialysis survival: A historical cohort study. J Am Soc Nephrol 16;2005:1115–25.

    PubMed  Article  CAS  Google Scholar 

  40. Margolis JR, Chen JT, Kong Y, Peter RH, Behar VS, Kisslo JA, The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases. Radiology 137;1980:609–16.

    PubMed  CAS  Google Scholar 

  41. Watson KE, Abrolat ML, Malone LL, Hoeg JM, Doherty T, Detrano R, Demer LL, Active serum vitamin D levels are inversely correlated with coronary calcification. Circulation. 96;1997:1755–60.

    PubMed  CAS  Google Scholar 

  42. Sambrook PN, Chen JS, March LM, Cameron ID, Cumming RG, Lord SR, Schwarz J, Seibel MJ, Serum parathyroid hormone is associated with increased mortality independent of 25-hydroxy vitamin d status, bone mass, and renal function in the frail and very old: a cohort study. J Clin Endocrinol Metab. 89;2004:5477–81.

    PubMed  Article  CAS  Google Scholar 

  43. Pepe J, Romagnoli E, Nofroni L, Pacitti MT, De Geronimo S, Letizia C, Tonnarini G, Scarpiello A, D’Erasmo E, Minisola S, Vitamin D status as the major factor determining the circulating levels of parathyroid hormone: a study in normal subjects. Osteoporos Int 16;2004:805–12.

    PubMed  Article  CAS  Google Scholar 

  44. Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS, Hypovitaminosis D in medical inpatients. N Engl J Med 338;1998:777–83.

    PubMed  Article  CAS  Google Scholar 

  45. Saleh FN, Schirmer H, Sundsfjord J, Jorde R, Parathyroid hormone and left ventricular hypertrophy. Eur Heart J 24;2003:2054–60.

    PubMed  Article  CAS  Google Scholar 

  46. Kamycheva E, Sundsfiord J, Jorde R, Serum parathyroid hormone levels predict coronary heart disease: the Tromso Study. Eur J Cardiovasc Prev Rehabil. 11;2004:69–74.

    PubMed  Article  Google Scholar 

  47. Karlsson SL, Indridason OS, Franzson L, Sigurdsson G, Prevalence of secondary hayperparthyreodism (SHPT) and causal factors in adult population in Reykjavik area. Laeknabladid 91;2005:161–9 [in Icelandic].

  48. McGonigle RJ, Fowler MB, Timmis AB, Weston MJ, Parsons V, Uremic cardiomyopathy: potential role of vitamin D and parathyroid hormone.Nephron 1984;36:94–100.

    PubMed  CAS  Google Scholar 

  49. Park CW, Oh YS, Shin YS, Kim CM, Kim YS, Kim YS, Choi EJ, Chang YS, Bang BK, Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis 199;33:73–81.

  50. Zhu Y, Mahon BD, Froicu M, Cantorna MT. Calcium and 1alpha,25-dihydroxyvitamin D3 target the TNF-alpha pathway to suppress experimental inflammatory bowel disease." Eur J Immunol 2005;35:217–24.

    PubMed  Article  CAS  Google Scholar 

  51. Michel G, Gailis A, Jarzebska-Deussen B, Muschen A, Mirmohammadsadegh A, Ruzicka T, 1,25-(OH)2-vitamin D3 and calcipotriol induce IL-10 receptor gene expression in human epidermal cells. Inflamm Res 1997;46:32–4.

    PubMed  Article  CAS  Google Scholar 

  52. Canning MO, Grotenhuis K, de Wit H, Ruwhof C, Drexhage HA. 1-alpha,25-Dihydroxyvitamin D3 (1,25(OH)(2)D(3)) hampers the maturation of fully active immature dendritic cells from monocytes. Eur J Endocrinol 2001;145:351–7.

    PubMed  Article  CAS  Google Scholar 

  53. Mann DL, Young JB, Basic mechanisms in congestive heart failure. Recognizing the role of proinflammatory cytokines. Chest 1994;105:897–904.

    PubMed  CAS  Google Scholar 

  54. Rauchhaus M, Doehner W, Francis DP, Davos C, Kemp M, Liebenthal C, Niebauer J, Hooper J, Volk HD, Coats AJ, Anker SD, Plasma cytokine parameters and mortality in patients with chronic heart failure. Circulation 2000;102:3060–7.

    PubMed  CAS  Google Scholar 

  55. Kell R, Haunstetter A, Dengler TJ, Zugck C, Kubler W, Haass M. Do cytokines enable risk stratification to be improved in NYHA functional class III patients? Comparison with other potential predictors of prognosis.Eur Heart J 2002;23:70–8.

    PubMed  Article  CAS  Google Scholar 

  56. Mathieu C, Adorini L.The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents." Trends Mol Med 2002;8:174–9.

    PubMed  Article  CAS  Google Scholar 

  57. Goswami R, Gupta N, Goswami D, Marwaha R, Tandon N, Kochupillai N, Prevalence and significance of low 25-hydroxyvitamin D concentrations i healthy subjects in Delhi. Amer J Clin Nutr 72;2000:472–5.

    PubMed  CAS  Google Scholar 

  58. Holick MF, Vitamin D. The underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 9;2002:87–98.

    Article  CAS  Google Scholar 

  59. Wolpowitz D, Gilchrest BA, The vitamin D questions: How much do you need and how should you get it? J Am Acad Dermatol 54;2006:301–17.

    PubMed  Article  Google Scholar 

  60. Parrish JA, Immunosuppression, skin cancer, and ultraviolet A radiation. New Engl J Med 353;2006:2712–13.

    Article  Google Scholar 

  61. Stephens WP, Klimuik PS, Berry JL, Mawer EB, Annual high-dose vitamin D prophylaxix in Asian immigrants. Lancet 2 (8257);1981:1199–1202.

    PubMed  Article  CAS  Google Scholar 

  62. Toss G, Larsson L, Lindgren S, Serum levels of 25-hydrioxyvitamin D in adults and elderly humans after a prophylactic dose of vitamin D2.Scand J Clin Invest 43;1983:329–32.

    PubMed  CAS  Article  Google Scholar 

  63. Burns J, Paterson CR, Single dose vitamin D treatment for osteomalacia in the elderly. Br Med J 290;1985:281–2.

    CAS  Article  Google Scholar 

  64. Davies M, Mawer EB, Hann JT, Stephens WP, Taylor JL, Vitamin D prophylaxis in the elderly : A simple effective method suitable for large populations. Age and Adeing 14:1985:349–54.

    CAS  Google Scholar 

  65. Nordin BEC, Baker MR, Horsman A, Peacock M, A prospective trial of the effect of vitamin D supplementation on metacarpal bone loss in elderly women. Am J Clin Nutr 42;1985:470–4.

    PubMed  CAS  Google Scholar 

  66. Weisman Y, Schen RJ, Eisenberg Z, Amarilio N, Graff E, Edelstein-Singer M, Goldray D, Harell A, Single oral high-dose vitamin D3 prophylaxis in the elderly. J Am Geriatr Soc 34;1986:515–18.

    PubMed  CAS  Google Scholar 

  67. Glerub H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H, Charles P, Eriksen EF, Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 66;2000:419–24.

    Article  Google Scholar 

  68. Dhesi JK, Jackson SHD, Bearne LM, Moniz C, Hurley MV, Swift CG, Allain TJ, Vitamin D supplementation improves meuromuscular function in elderly people who fall. Age and Ageing 33;2004:589–95.

    PubMed  Article  Google Scholar 

  69. Diamond TH, Ho KW, Rohl PG, Meerkin M, Annual intramuscular injection of a megadose of cholecalciferol for treatment of vitamin D deficiency: efficacy and safety data. MJA 183;2005:10–12.

    PubMed  Google Scholar 

  70. Trang H, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R, Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr 68;1998: 854–8.

    PubMed  CAS  Google Scholar 

  71. Mastaglia SR, Mautalen CA, Parisi MS, Oliveti B, 2006. Vitamin D(2) dose required to rapidly increase 25OHD levels in osteoporotic women. Eur J Clin Nutr Jan 4 [Epub ahead of print].

  72. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ, Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77;2003:204–10.

    PubMed  CAS  Google Scholar 

  73. Graafmanns WC, Lips P, Ooms ME, Van Leeuwen JPTM, Pols HAP, Uitterlinden AG, The effect of vitamin D supplementation on the bone mineral density of the femoral neck is associated with vitamin D receptor genotype. J Bone Miner Res 12;1997:1241–5.

    Article  Google Scholar 

  74. Meyer HE, Smedshaug GB, Kvaavik E, Falch JA, Tverdal A, Pedersen JI, Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomised controlled trial. J Bone Miner Res 17;2002:709–15.

    PubMed  Article  CAS  Google Scholar 

  75. Larsen ER, Mosekilde L, Foldspang A, Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: A pragmatic population-based 3-year-intervention study. J Bone Miner Res 19;2004:370–8.

    PubMed  Article  CAS  Google Scholar 

  76. Hunter D, Major P, Arden N, Swaminathan R, Andrew T, Macgregor AJ, Keen R, Snieder H, Spector TD, A randomised controlled trial of vitamin D supplementation on preventing postmenopausal bone loss and modifying bone metabolism using identical twin pairs. J Bone Miner Res 15;2000:2276–83.

    PubMed  Article  CAS  Google Scholar 

  77. Harris SS, Dawson-Hughes B, Plasma vitamin D and 25OHD responses of young and old men to supplementation with vitamin D3. J Am Coll Nutr 21;2002:357–62.

    PubMed  CAS  Google Scholar 

  78. Bischoff HA, Stähelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Bergerow B, Lew RA, Conzelmann M, Effects of vitamin D and calcium supplementation on falls: A randomised controlled trial. J Bone Miner Res 18;2003:343–51.

    PubMed  Article  CAS  Google Scholar 

  79. Vieth R, Chan PCR, MacFarlane GD, Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 73;2001:288–94.

    PubMed  CAS  Google Scholar 

  80. Tangpricha V, Koutkia P, Rieke SM, Chen TC, Perez AA, Holick MF, Fortification of orange juice with vitamin D: A novel approach for enhancing vitamin D nutritional health. Am J Clin Nutr 77;2003:1478–83.

    PubMed  CAS  Google Scholar 

  81. Harris SS, Dawson-Hughes B, Perrone GA, Plasma 25-hydroxyvitamin D responses of younger and older men to three weeks of supplementation with 1800 IU/day of vitamin D. J Am Coll Nutr 18;1999:470–4.

    PubMed  CAS  Google Scholar 

  82. Deswal A, Bozkurt B, Seta Y, Parilti-Eiswirth S, Hayes FA, Blosch C, Mann DL, Safety and efficacy of a soluble P75 tumor necrosis factor receptor (Enbrel, etanercept) in patients with advanced heart failure. Circulation 1999;99:3224–6.

    PubMed  CAS  Google Scholar 

  83. Kubota T, Bounoutas GS, Miyagishima M, Kadokami T, Sanders VJ, Bruton C, Robbins PD, McTiernan CF, Feldman AM, Soluble tumor necrosis factor receptor abrogates myocardial inflammation but not hypertrophy in cytokine-induced cardiomyopathy. Circulation 2000;101:2518–25.

    PubMed  CAS  Google Scholar 

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  1. Klinik für Thorax- und Kardiovaskularchirurgie, Herzzentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bad Oeynhausen, Germany

    Armin Zittermann, Stefanie S. Schleithoff & Reiner Koerfer

  2. Department of Cardio-Thoracic Surgery, Heart Center Northrhine-Westfalia, Ruhr University of Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany

    Armin Zittermann

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  1. Armin Zittermann
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Zittermann, A., Schleithoff, S.S. & Koerfer, R. Vitamin D insufficiency in congestive heart failure: Why and what to do about it?. Heart Fail Rev 11, 25–33 (2006). https://doi.org/10.1007/s10741-006-9190-8

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Keywords

  • Heart failure
  • Vitamin D
  • Parathyroid hormone
  • Mobility
  • Ultraviolet B