Vitamin D, Heart Dysfunction Tied in Thalassemia. Take Vitamin D, Please

Vitamin D, heart dysfunction tied in thalassemia.
By: Lowry, Fran
Publication: Family Practice News
Date: Saturday, March 1 2008


ATLANTA -- Vitamin D deficiency was strongly associated with high cardiac iron and increased ventricular dysfunction in a retrospective review of 24 young thalassemia major patients.
A review of their medical records showed levels of vitamin D(25[OH]D), the predominant circulating form of vitamin D, were "markedly depressed" in 13 patients and borderline depressed in the remaining patients, said Dr. John C. Wood of Children's Hospital Los Angeles and Keck School of Medicine at the University of Southern California, Los Angeles. There were 11 girls and 13 boys; mean age was 15 years.
Vitamin D(25[OH]D) levels less than 20 ng/mL are considered deficient and D(251OH]D) levels 20-30 ng/mL are borderline or insufficient, Dr. Wood said in a presentation at the annual meeting of the American Society of Hematology. In this study, the mean D(25[OH]D) was 17 ng/mL. The vitamin D levels were then com pared with cardiac R2*--a surrogate MRI measure of the amount of iron in the heart--and left ventricular ejection fraction (LVEF) from each patient's most recent cardiac MRI. As vitamin D levels decreased, cardiac R2* increased. Vitamin D(25[OH]D) levels below 13 ng/mL were associated with severe cardiac iron loading. LVEF also decreased as D25OH decreased.

"In our MRI laboratory, an ejection fraction less than 56% is considered abnormal and indicates poor pump function. In these patients, there was a proportional association between vitamin D(25[OH]D) levels and cardiac function. The four patients with the lowest D(25[OH]D) had an LVEF between 50% and 54%," he said.
The population also was moderately iron overloaded, with mean ferritin levels of 2,089 ng/mL, liver iron 14 mg/g dry weight, transferrin saturation 84%, and cardiac R2* 65 Hz. The normal R2* should not exceed 50 Hz. "Vitamin D deficiency ... is extremely common in thalassemia. Twenty-three of the 24 patients in our study had levels that are considered inadequate to ensure optimal calcium absorption and bone mineralization," he said in an interview. Low vitamin D is linked to decreased cardiac function, muscle weakness, glucose insensitivity, and refractory congestive heart failure.
Increased iron in the heart becomes evident in children with thalassemia major around the age of 9 years. Two-thirds of adults with thalassemia have cardiac iron deposition. Iron cardiomyopathy is the leading cause of death in thalassemia. "Our study describes an association between low vitamin D, high cardiac iron, and increased ventricular dysfunction. We cannot prove [cause and effect], but vitamin D might be worsening the cardiac iron overload and the cardiac dysfunction through its modulation of calcium signaling in these patients."
"Vitamin D deficiency is extremely common in thalassemia, and since osteoporosis is ubiquitous in this disease, vitamin D screening and replacement are probably indicated regardless of the heart findings," Dr. Wood said.
He added that low vitamin D produces secondary hyperparathyroidism, which exacerbates heart failure of any etiology. Because of this, thalassemia patients with ventricular dysfunction should have their vitamin D levels assessed, and replacement should be started if these levels are low.
The National Heart, Lung, and Blood Institute, the Centers for Disease Control and Prevention, and Novartis Pharma funded the study. Dr. Wood disclosed he receives research funding and honoraria from Novartis and Apotex, and is a consultant to Novartis.

I have met Dr Wood at two conferences and he is one of the most dedicated doctors in the world. He is also a wonderful man who is always willing to take the time to talk to patients and parents. His research leads the world in heart related issues in thalassemia. If every hospital in the world followed the protocol he has designed for treating heart failure in thalassemics, there would be far fewer premature deaths among thals. With this said, I must highly recommend that ALL thal patients take vitamin D. I would recommend a minimum of 2000 IU daily for adults (1000 IU minimum for children). For those with demonstarted deficiencies of vitamin D, I would strongly recommend once monthly IV treatments with vitamin D in quantities up to 60,000 IU.

After reading this, all I can say is if you are not taking vitamin D, why not?

Please pay special attention to this line.

vitamin D screening and replacement are probably indicated regardless of the heart findings

Lil Z is taking Vitamin D only in Osteocare,is it enough? For her deficiency her hemo said a shot of Vitamin D will be enough which contains 6000 units of vitamin D.And she had that shot once.

Zaini.

Zaini,

Because you live in a place where it is possible to get a lot of sun regularly, I would suggest that Zainab get at least 30 minutes of sunlight daily. Bare arms. She should also be occasionally tested to see if her levels are high enough. If she can't get sun, take extra vitamin D.

i take only vitamin d 0.26 mcg daily. I have osteopenia.

Dore,

My thoughts are you need to be taking vitamin D. It is usually not lack of calcium but lack of vitamin D that causes osteo problems. Calcium cannot be absorbed without also having enough vitamin D. Vitamin D is actually a hormone and it is required to fix over 40 different nutrients in the body. Without enough vitamin D receptors, these nutrients will not be adequately absorbed.

Thanks Andy,I'll try to keep a watch.

My mother has also been advised by the doctor to check her Vitamin D and B12,and a Dexa Scan too.

Zaini.

How much IU is mg? 

Hi Dore,

Please check this link

http://en.wikipedia.org/wiki/International_unit

Zaini.

Andy,

I have been reading a lot about autoimmune disorders - mostly about autoimmune hemolytic anemia.  Most of the research suggests that while prednisone, rituximab and other immunosuppressants are helpful - vitamin D megadoses are very important. 

Little A was very vitamin D deficient when he was first tested in 2008.  Chances are that he may have been deficient for a long time, I think that vitamin D deficiency along with receiving improperly matched blood for years led to the antibody that he now has.  His vitamin D levels have gone up because I have been supplementing him, but I do wonder if it is enough.  I wonder, if his vitamin D levels are restored - and now that his blood is DNA matched if it would help the antibody titers remain low. 

I think that increasing his vitamin D levels will be good for him in many ways - including his cardiovascular and bone health. 

I hope that all thals will look into this.   Low vitamin D levels are highly correlated with autoimmune problems.

Sharmin

I have to agree that vitamin D deficiency is at the root of many problems, and what Dr Mercola said about flu outbreaks during the season when people are getting the least amount of vitamin D makes a lot of sense. Vitamin D regulates the absorption of over 40 other nutrients, so it makes sense that D is crucial to good health and a well regulated immune system. Sharni, I think your continued efforts to regulate little A's immune system is as important as anything else that is being done for this problem. Vitamin D levels need to be at least 30 and Mercola is suggesting minimum 50, so most of us have a long way to go to get to this level. I am currently taking 5000 IU daily and considering going to 10,000 for the winter.

I am only taking 1000 IU  ,and Z is on 800 IU.

Andy...thank you very much indeed...will be forwarding on. Having experienced with both my boys I have realised that their vitamin D levels tend to dip significantly after taking the supplement for about 2-3 months. They do need to be taking vitamin D all the time to maintain acceptable level. The vitamin D test were only carried out because I requested it and not because of consultant request. Also I have realised that although the calcium levels as with BB, shows that it is normal, other investigations in testing for a more accurate reading should be done. We were not aware of this because the results were just sitting around in one of their consultants records but BB's bone mineral density was significantly reduced although his calcium readings appeared normal. The Dexa scan was carried out in April (!) but everytime we visited with their consultant nothing was said although we did enquire. Perhaps the results were delayed in getting to them...don't know. I also realise that as parents we always need to be ten steps ahead because some of the professionals just keep dragging.
....Thanks a ton anyways.

When I was first tested for Vitamin D status 2 years ago my hemoglobin was averaging 7.  I tried different supplements but had reactions to all of them (headaches, bruising, etc).  So I bought an old sun lamp on eBay and a vitamin D meter which gives you the equivalent of vitamin D in units from the UV light. 

I only do 10 minutes with the lamp per day since you don't want to get enough to tan, just enough to stimulate vitamin D production.  With my lamp that translates into 3000 units of D per exposure.  My blood count started rising and stays around 9-10 now, but only if I do the sun lamp every day.  If I miss several days the count starts going down.  My immune profile also improved dramatically and the cancer I had in my kidney started shrinking. 

I am a firm believer in Vitamin D therapy, either supplements or reasonable UV exposure.  Tanning beds are not a good way to get UV, but the older lamps with a large bulb have a broad spectrum of UV and work fine.  Where I live there is not adequate UV from sunlight from October through April.  My meter tells me exactly how much I'm getting from outside light, too, but it's much less predictable than using a lamp.


Jan

Jan,

Thanks for the feedback. I am convinced that vitamin D deficiency is a cause of many of the health problems we face as humans. It is almost impossible in today's world to get enough D from the sun, so we need to find alternatives.

Andy Sir...Did You Find Any Alternatives...?