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      Vitamin D deficiency causes diseases

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NEW YORK (Reuters Health) Apr 28 - Lower vitamin D levels and higher C-reactive protein levels are associated with poor aerobic capacity and greater frailty in elderly patients with heart failure, according to findings published in the March issue of the Journal of the American Geriatric Society.

"Neurohormones, anabolic and catabolic hormones, and inflammatory mediators have been identified as contributors to the functional decline and frailty that occur in patients with heart failure," Dr. Rebecca S. Boxer, of Case Western Medical Center, Cleveland, Ohio, and colleagues write. They hypothesized that factors known to affect muscle health -- testosterone, dehydroepiandrosterone sulphate (DHEAS), cortisol, vitamin D -- and the inflammatory markers high-sensitivity C-reactive protein (hsCRP) and IL-6 "would be associated with physical capacity and frailty in patients with heart failure."

To investigate, the researchers measured 6-minute walk distance and frailty phenotype in 60 patients with an ejection fraction of 40% or less. Of the 60 patients, 43 were men (mean age 77 years) and 17 were women (mean age 78 years). The mean ejection fraction was 29%.

A correlation was observed between a longer 6-minute walk distance and higher vitamin D level, lower cortisol:DHEAS ratio, and lower hsCRP and IL-6 levels. No correlation was found with percentage of free testosterone or DHEAS.

A higher frailty phenotype score (greater frailty) correlated with higher hsCRP and IL-6 levels and lower vitamin D level.

On further analysis, age, sex, vitamin D, and hsCRP were each independently associated with 6-minute walk distance, and age, vitamin D, and hsCRP were predictive of frailty status.

The authors note that interventions geared toward raising vitamin D and lowering CRP levels in heart failure patients are possible, but "it remains unclear whether vitamin D therapy has a role in the management of elderly patients with HF." If it is shown that "vitamin D therapy improves physical performance and modulates the inflammatory response, this could become an attractive therapy for patients with HF."

J Am Geriatr Soc 2008;56:454-461.

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