The impact of calcium and vitamin D supplement intake on survival in patients with concomitant moderate aortic and mitral valve disease

Abstract Background Calcium and vitamin D supplement intake has increased among the elderly population, who are prone to deficiency. We sought to assess the association between calcium and vitamin D supplementation and the long-term outcomes in patients diagnosed with concomitant moderate aortic and mitral valve disease. Methods We included 3257 patients (aged 71.7 ± 12.9 years; 55.2% male; 83.1% white), who presented to the Cleveland Clinic between 2010 and 2018, diagnosed with concomitant moderate aortic and mitral valves disease. The patients were followed up with a mean period of 21.8 months (range 1-155.8). Patients were stratified based on the supplementation with calcium and vitamin D. Focusing on the aortic component of the concomitant valvular disease, patients were further subdivided into two groups; Aortic Stenosis (AS) with either Mitral Regurgitation (MR) or Stenosis (MS)(group 1), and Aortic Regurgitation (AR) with either MR or MS(group 2). The primary endpoints were death and heart failure hospitalization. The data was analyzed using Kaplan Meier survival analysis on SPSS. Results Of the total 3257 patients included in this study, 2273 (70%) were not supplemented, and 984 (30%) were supplemented with calcium and vitamin D. Supplementation with calcium and vitamin D was significantly associated with a higher risk of all-cause mortality (HR=1.114, 95% CI [1.003-1.237]; p=0.043) (Figure 1). However, no significant association with heart failure hospitalization was noted (HR=1.003, 95% CI [0.884-1.139]; p=0.958). On further sub-group analysis of the aortic component, 1045 (32%) patients in group 1 and 2212 (68%) patients in group 2 were assessed. In group 1, 701 (67%) patients were not supplemented, and 344 (33%) were supplemented. Calcium and vitamin D supplementation was associated with a significantly higher risk of all-cause mortality in patients with AS (HR=1.203, 95% CI [1.017-1.425]; p=0.031). Conversely in patients with AR (group 2), 1572 (71%) patients were not supplemented, and 640 (29%) were supplemented, and no significant association was exhibited in this group (HR=1.044, 95% CI [0.913-1.193]; p=0.531) (Figure 2). Conclusion In our cohort of patients with concomitant moderate aortic and mitral valve disease, the intake of calcium and vitamin D supplements was associated with higher mortality specifically in patients with aortic stenosis.Figure 1Figure 2