Vitamin D in the prevention of left ventricular remodelling after an acute myocardial infarction: a randomized clinical trial

Abstract

No clinical trial has yet assessed the effect of vitamin D on patients experiencing ST-segment elevation myocardial infarction (STEMI). In this multicentre, randomised (2:1), double-blind, placebo-controlled trial, 93 patients with anterior STEMI were randomised to calcifediol or placebo, for 12 months. The primary endpoint was left ventricular remodelling, defined as a 15% increase in left ventricular end-diastolic volume (EDV) on magnetic resonance imaging. Sixty-five patients were allocated to calcifediol and 28 to placebo. Calcidiol levels increased in the intervention group (20.0[8.4, 36.5] vs. 2.0[? 0.3, 4.5] ng/mL, p < 0.001). No differences were observed in the incidence of left ventricular remodelling (26.2% vs. 21.4%; p = 0.824) and in these secondary end points: increment in end-diastolic volume (6.0[? 6.5, 21.6] vs. 6.1[? 8.1, 23.8] mL; p = 0.773), end-systolic volume (? 6.9[? 15.9, 4.5] vs. 1.3[? 20.9, 17.2] mL; p = 0.908), ejection fraction (5.1[2.1, 10.0] vs. 7.7[? 0.9, 11.0]%; p = 0.992), and in plasma levels of N-terminal pro-brain natriuretic peptide, galectin-3, ST2, growth differentiation factor-15, fibroblast growth factor-23 (FGF23), high-sensitivity C-reactive protein, and monocyte chemoattractant protein-1. Similar results were observed in patients with baseline FGF23 above the median, in those with calcidiol < 30 ng/mL, and in the subgroup with ejection fraction ? 40%. In conclusion, calcifediol does not improve left ventricular remodelling or affect biomarkers related to heart failure and inflammation following a STEMI.Trial registration: NCT02548364. https://clinicaltrials.gov/study/NCT02548364?term=VITDAMI%20Vitamin%20D%20in%20acute%20myocardial%20infarction&rank=1 .