Vitamin D, cardio-inflammation, and endothelial dysfunction in older adults after orthopedic surgery: Results from an open-label trial to ameliorate cardiac function

Objectives. - After orthopedic surgery, clinical outcomes are affected by comorbid cardiovascular diseases (CVDs) and low 25-hydroxy-vitamin D (25-( OH)D). Myocardial function was suggested to be influenced by both the pro-inflammatory cytokine tumour necrosis factor alpha (TNF alpha) and the marker of endothelial dysfunction asymmetric dimethylarginine (ADMA).Material and methods. - We investigated TNF alpha. and ADMA changes in association with serum levels of vitamin D and cardiac function in 47 older adults after major orthopedic surgery. Subjects were characterized for biochemical profiles and transthoracic echocardiographic measures. Assessments were done before and after the correction of hypovitaminosis D through a 6-month supplementation with calcifediol started at post-operative rehabilitation.Results. - The means serum levels of both TNF alpha. and ADMA reduced from 1.39 +/- 0.47 pg/mL to 1.30 +/- 0.37 pg/mL (P< 0.05) and from 0.69 +/- 0.05 mu mol/L to 0.68 +/- 0.04 mu mol/L (P < 0.05), respectively. Significant treatment effects were observed for systolic blood pressure (P< 0.05), left ventricular ejection function (P < 0.01), global longitudinal strain (P< 0.0001), 25-( OH)D (P < 0.001), and calcemia (P< 0.001).Conclusion. - After the normalization of low levels of vitamin D, we were able to observe a reduction of circulating TNF alpha. and ADMA together with the amelioration of cardiac function. Even if our results suggest that vitamin D might exert cardiac effects indirectly through the decrease in cardio-inflammation and endothelial dysfunction, a better understanding of the precise molecular regulations should be better investigated. (C) 2020 Societe francophone nutrition clinique et metabolisme ( SFNCM). Published by Elsevier Masson SAS. All rights reserved.