What is it about?
The exact molecular pathways involved in vitamin D cardiac effects are still unidentified, but two putative molecules may indirectly mediate its effects: the pro-inflammatory cytokine tumor necrosis factor alpha (TNFα), which known to be associated with many chronic CVDs, and the asymmetric dimethylarginine (ADMA), which is involved in nitric oxide (NO) bioactivity in the vascular wall. Several studies showed that vitamin D is able to counteract the release of TNFα. This humoral response may be mediated by vitamin D receptors (VDRs) that are significantly present in almost all immune cell types, such as T lymphocytes and macrophages, to up-regulate the synthesis of anti-inflammatory cytokines, such as interleukin-10. Moreover, the immunological roles of this vitamin are further attested by the macrophage expression of 1-α-hydroxylase, which is the enzyme responsible for the production of the active form of vitamin D (i.e. calcitriol). Circulating levels of vitamin D and ADMA levels were shown to be inversely associated. Mechanisms through which the normalization of vitamin D could be associated with serum levels of ADMA may partly overlap with the abovementioned anti-inflammatory effect, such as the indirect reduction of vascular resistance or the down-regulation of macrophages activation. Another suggested mechanism involves the promotion of NO synthesis by endothelial cells indirectly via expression of the vascular endothelial growth factor (VEGF) gene.
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Why is it important?
Vitamin D plays a key role not only in the well-known maintenance of calcium homeostasis and bone mineral density, but also in the skeletal muscle contraction and cardiovascular function, thus contributing to preserve left ventricular function and even ameliorate a previously altered ventricular output. Manifest consequences of low circulating levels of vitamin D have negative effects on cardiac anatomy, ventricular output, vascular perfusion, wound healing potential, pro- to anti-inflammatory cytokines balance, and oxidative stress. It is necessary to investigate the association of serum trends of TNFα and ADMA with the postoperative amelioration of cardiac function upon vitamin D supplementation. The results could elucidate some of the proposed mechanisms of vitamin D cardiac effects.
Perspectives
To improve long-term outcomes, older adults suffering from CVDs and vitamin D deficiency may benefit from supplementation programs started immediately after orthopedic surgery. However, integrative interventions can be applied even before surgery and pre-admission protocols that comprise multimodal interventions were already suggested in both Orthopedics and Cardiology. For instance, lifestyle interventions may comprise advices on outdoor physical activity to increase sun exposure, but also to take advantage from aerobic conditioning. Smoking cessation, diabetic control, sleep and social functioning optimization can be also part of the multimodal approach to improve medical and surgical outcomes. We may suppose that dietary interventions can be the first line treatment also for correcting hypovitaminosis D in patients with CVDs undergoing elective orthopedic surgery, but they should be addressed weeks before the intervention. Future comprehensive studies should be planned to investigate and address the best perioperative practices, keeping in mind that each intervention may hide a dark side. For instance, foods rich in vitamin D may be included in a daily diet in order to meet the subject's requirement, but they are also a major source of cholesterols that is deleterious to cardiovascular health.
Dr. M. Briguglio
IRCCS Ospedale Galeazzi - Sant'Ambrogio
Read the Original
This page is a summary of: Vitamin D, cardio-inflammation, and endothelial dysfunction in older adults after orthopedic surgery: Results from an open-label trial to ameliorate cardiac function, Nutrition Clinique et Métabolisme, December 2020, Elsevier,
DOI: 10.1016/j.nupar.2020.06.003.
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Resources
Il ruolo della Vitamina D in chirurgia protesica
Uno studio condotto al Galeazzi di Milano da un cardiologo e un nutrizionista suggerisce di correggere l’ipovitaminosi D prima dell’intervento di chirurgia protesica: «il miglioramento della funzionalità cardiaca può ridurre le complicanze»
Vitamin D, SARS-CoV-2, and COVID-19
Vitamin D supplementation may be useful besides its potential effects on SARS-CoV-2 infection and COVID-19.
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