Vitamin D deficiency in the development of pediatric syncope due to orthostatic hypotension
DOI:
https://doi.org/10.11603/bmbr.2706-6290.2022.4.13241Keywords:
vitamin D deficiency, autonomic nervous system, syncope due to orthostatic hypotension, childrenAbstract
Summary. The existence of a contradictory understanding of the role of vitamin D deficiency in the genesis of orthostatic hypotension, which is based mainly on research in small groups of adults, substantiates the relevance of studying this problem among children.
The aim of the study – to investigate the serum vitamin D level in children with syncope due to orthostatic hypotension (OH), as well as its relationship with the indicators of functional cardiovascular system state.
Materials and Methods. 24 children with the diagnosis of syncope due to OH and 24 relatively healthy children aged 8–17 years were examined. As an indicator of vitamin D availability, the level of 25(OH)D in serum was determined by enzyme immunoassay method. The calculation of integral indicators of the functional cardiovascular system state was carried out according to the data of the physical examination using empirical formulas. Heart rate variability (HRV) was studied based on the results of Holter monitoring during a 24-hour period of normal functioning.
Results. A significantly lower level of vitamin D was recorded in patients with syncope due to OH compared to healthy respondents (19.9±1.4), (30.9±1.2) ng/ml; p=0.000001). A decrease in systolic blood pressure in the supine position and during the 1st, 3rd, 5th, 7th, 10th minutes of active orthostasis was found on the background of a decrease in the serum concentration of vitamin D in the group of syncope due to OH (p<0.05). A decrease in the level of vitamin D was also accompanied by a decrease in the minute volume of blood flow (r=0.39; p=0.04), the circulatory system coefficient of efficiency (r=0.59; p=0.001), the left ventricle power (r=0 .66; p=0.0001), Robinson index (r=0.54; p=0.003), Hildebrandt coefficient (r=0.44; p=0.02), functional changes index (r=0.58; p=0.001), and cardiac index (r=0.64; p=0.0003). No statistically significant correlations between time (SDАNN, RMSSD, pNN50) and frequency (TP, VLF, LF, HF, LF/HF) indicators of HRV and the level of 25(ОН)D were found (p>0.05).
Conclusions. Significantly lower serum 25(OH)D levels were recorded, and the prevalence of vitamin D deficiency was 54.2 % in the group of children with syncope due to OH. The results of this study confirm the close connection of vitamin D deficiency with a decrease in the cardiovascular system adaptive mechanisms. HRV indicators do not depend on the serum level of vitamin D in children with syncope due to OH.
References
Danik JS, Manson JE. Vitamin d and cardiovascular disease. Curr Treat Options Cardiovasc Med. 2012;14(4): 414-24. DOI: 10.1007/s11936-012-0183-8.
Kheiri B, Abdalla A, Osman M, Ahmed S, Hassan M, Bachuwa G. Vitamin D deficiency and risk of cardiovascular diseases: a narrative review. Clin Hypertens. 2018;24: 9. DOI: 10.1186/s40885-018-0094-4.
Ghassab R. The effect of vitamin D deficiency and vitamin D supplementation on the risk of cardiovascular diseases. Family Medicine & Primary Care Review. 2021;23(1): 87-92. DOI: 10.5114/fmpcr.2021.103161.
Zhang Q, Sun Y, Zhang C, Qi J, Du J. Vitamin D Deficiency and Vasovagal Syncope in Children and Adolescents. Front Pediatr. 2021;9: 575923. DOI: 10.3389/fped.2021.575923.
Wadhwania R. Is Vitamin D Deficiency Implicated in Autonomic Dysfunction? J Pediatr Neurosci. 2017;12(2): 119-23. DOI: 10.4103/jpn.JPN_1_17.
Barbarawi M, Kheiri B, Zayed Y, Barbarawi O, Dhillon H, Swaid B, et al. Vitamin D supplementation and cardiovascular disease risks in more than 83 000 individuals in 21 randomized clinical trials: A meta-analysis. JAMA Cardiol. 2019;4(8): 765-76. DOI: /10.1001/jamacardio.2019.1870.
Gilani A, Ramsay SE, Welsh P, Papacosta O, Lennon LT, Whincup PH, Wannamethee SG. Vitamin D deficiency is associated with orthostatic hypotension in older men: a cross-sectional analysis from the British Regional Heart Study. Age and Ageing. 2021;50(1): 198-204. DOI: 10.1093/ageing/afaa146.
Soysal P, Yay A, Isik A.T. Does vitamin D deficiency increase orthostatic hypotension risk in the elderly patients? Archives of Gerontology and Geriatrics. 2014;59(1): 74-7. DOI: 10.1016/j.archger.2014.03.008.
Zuin M, Brombo G, Capatti E, Romagnoli T, Zuliani G. Orthostatic hypotension and vitamin D deficiency in older adults: systematic review and meta-analysis. Aging Clin Exp Res. 2022;34(5): 951-8. DOI: 10.1007/s40520-021-01994-w.
Laird EJ, McNicholas T, O'Halloran AM, Healy M, Molloy AM, Carey D, et al. Vitamin D status is not associated with orthostatic hypotension in older adults. Hypertension. 2019;74(3): 639-44. DOI: 10.1161/HYPERTENSIONAHA.119.13064.
Tanaka H, Fujita Y, Takenaka Y, Kajiwara S, Masutani S, Ishizaki Y, et al. Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr Int. 2009;51(1): 169-79. DOI: 10.1111/j.1442-200X.2008.02783.x.
Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21): 1883-948. DOI: 10.1093/eurheartj/ehy037.
Płudowski P, Karczmarewicz E, Bayer M, Carter G, Chlebna-Sokół D, Czech-Kowalska J, et al. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013;64(4): 319-27. DOI: 10.5603/ep.2013.0012.
Malikov MV, Svat'yev AV, Bohdanovska NV. [Functional diagnostics in physical education and sports: Study guide for students of higher educational institutions]. Zaporizhzhia, ZDU. 2006. Ukrainian.
Antiel RM, Caudill JS, Burkhardt BE, Brands CK, Fischer PR. Iron insufficiency and hypovitaminosis D in adolescents with chronic fatigue and orthostatic intolerance. South Med J. 2011;104(8): 609-11. DOI: 10.1097/SMJ.0b013e3182246809.
Shaltout HA, Glock MS. Low serum Vitamin D is associated with greater impairment in autonomic function upon head up tilt in children with orthostatic intolerance. Poster Abstract Presentations Hypertension. 2015;66:AP633. Available from: http://hyper.ahajournals.org/content/66/Suppl_1/AP633/tab-article-info
Xu WR, Jin HF, Du JB. Vitamin D and Cardiovascular Risk in Children. Chinese medical journal. 2017;130(23): 2857-62. DOI: 10.4103/0366-6999.215500.
Marushko YuV, Gyshhak TV. [System adaptation mechanisms. Stress in children]. Kyiv. 2014. Ukrainian.
Kovalchuk TA, Luchyshyn NYu. [The levels of adaptive cardiovascular system mechanisms functioning in children with different syncope genesis] Suchasna pediatriia. Ukraina. 2022;3: 16-26. Ukrainian.
Dogdus M, Burhan S, Bozgun Z, Cinier G, Koyuncu I, Yucel Karabay C, Zoghi M. Cardiac autonomic dysfunctions are recovered with vitamin D replacement in apparently healthy individuals with vitamin D deficiency. Ann Noninvasive Electrocardiol. 2019;24(6): e12677. DOI: 10.1111/anec.12677.
Tak YJ, Lee JG, Kim YJ, Lee SY, Cho BM. 25-hydroxyvitamin D and its relationship with autonomic dysfunction using time- and frequency-domain parameters of heart rate variability in Korean populations: a cross-sectional study. Nutrients. 2014;6(10): 4373-88. DOI: 10.3390/nu6104373.
Zou R, Wang S, Cai H, Li F, Lin P, Wang Y, Wang C. Vitamin D deficiency in children with vasovagal syncope is associated with impaired circadian rhythm of blood pressure. Front Neurosci. 2021;15: 712462. DOI: 10.3389/fnins.2021.712462.
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