Vitamin D insufficiency and cardiovascular involvement in systemic sclerosis: Association with echocardiographic parameters and risk factors

Abstract

Background: Vitamin D plays several roles beyond bone metabolism, potentially protecting the cardiovascular system. Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis and vascular dysfunction, carrying a high cardiovascular risk. However, the relationship between vitamin D insufficiency and cardiovascular involvement in SSc patients remains unclear. This study aims to assess the association between low vitamin D levels, echocardiographic parameters indicative of ventricular dysfunction, and cardiovascular risk factors in SSc patients.

Methods: A retrospective observational study involved 160 SSc patients undergoing echocardiography and serum 25-hydroxyvitamin D measurement. Patients were categorized into two groups: vitamin D insufficiency (<30 ng/mL) and normal levels (≥30 ng/mL). Echocardiographic parameters and cardiovascular risk factors were evaluated.

Results: Vitamin D insufficiency was detected in 68.9 % of patients. Patients with insufficient vitamin D had higher systolic pulmonary arterial pressure (PAPs; 37.68 ± 7.56 mmHg vs. 33.12 ± 6.17 mmHg; p = 0.004), reduced TAPSE/PAPs ratio (0.65 ± 0.13 vs. 0.72 ± 0.14; p = 0.021), increased interventricular septal thickness (8.17 ± 1.28 mm vs. 7.69 ± 1.18 mm; p = 0.028), and greater left ventricular end-diastolic diameter (44.06 ± 4.28 mm vs. 42.67 ± 3.44 mm; p = 0.037), indicating ventricular dysfunction. Vitamin D insufficiency significantly correlated with hypertension (OR = 2.31; p = 0.032), dyslipidemia (OR = 2.45; p = 0.015), and overweight/obesity (OR = 4.73; p = 0.002), but not with diabetes or smoking.

Conclusions: Vitamin D insufficiency may contribute to cardiovascular dysfunction in SSc patients. Monitoring vitamin D levels might improve cardiovascular risk stratification. Further studies are necessary to determine if supplementation could enhance cardiac outcomes.

Keywords: Cardiovascular diseases; Echocardiography; Pulmonary hypertension; Risk factors; Systemic sclerosis; Vitamin D insufficiency.

Fig. 1

Left-ventricular structural echocardiographic variables in patients with normal vitamin D (≥30 ng/mL; n = 50) versus vitamin D insufficiency (<30 ng/mL; n = 110). Bars depict mean ± SD. Significant between-group differences were observed for LV end-diastolic diameter (LVEDD/DTD) and interventricular septal thickness (IVS), both higher in the insufficiency group (p = 0.037 and p = 0.028, respectively). Posterior wall thickness and indexed LV mass showed no between-group differences (all p ≥ 0.05). Group comparisons used Student's t-test or Mann–Whitney U test, as appropriate; significance was set at p < 0.05.

Fig. 2

Prevalence of cardiovascular risk factors in the study cohort (n = 160). Bars depict the proportion of patients with each risk factor: smoking 41.9 % (n = 67), BMI >25 kg/m²23.8 % (n = 38), hypertension 35.6 % (n = 57), diabetes mellitus 6.3 % (n = 10), and dyslipidemia 68.8 % (n = 110).