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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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