Calcium and vitamin D supplementation impact on survival in patients with moderate concomitant aortic and mitral valve disease

Calcium supplement intake, with or without vitamin D supplementation, has risen amongst the older population, who are more likely to have deficiencies. Our aim was to investigate how the supplementation of calcium and vitamin D is associated with survival in patients with moderate concomitant aortic and mitral valve disease. A total of 3,257 patients (mean age of 71.73 years; 55.2% male; 83.1% White) were diagnosed with moderate concomitant aortic and mitral valve disease at Cleveland Clinic between January 2010 and December 2020 and were included in this study. The patients were divided into two groups based on their supplement intake. Further subgroup analysis was performed, focusing on the aortic valve, leading to the stratification of patients into two subgroups-group 1: aortic stenosis (AS) combined with either mitral stenosis or regurgitation, and group 2: aortic regurgitation (AR) combined with either mitral stenosis or regurgitation. The study's primary outcome was the combined event of all-cause mortality and heart failure hospitalization. Of the 3,257 patients who were included, 70% of them (2,273 patients) did not receive supplements, and 30% (984 patients) had received calcium and vitamin D supplementation. The supplement intake was associated with a greater risk of all-cause mortality [hazard ratio (HR), 1.114; 95% confidence interval (CI): 1.003-1.237, P=0.043], but no significant association with heart failure hospitalization was observed (HR, 1.003; 95% CI: 0.884-1.139, P=0.96). The subgroup analysis based on the aortic valve showed that among the 1,045 patients in group 1, 67% did not receive supplements, and 33% received supplementation. Calcium and vitamin D supplementation was significantly associated with a greater risk of all-cause mortality in patients with AS (HR, 1.203; 95% CI: 1.017-1.425, P=0.03). Contrarywise, in group 2 of patients with AR consisting of 2,212 patients, 71% did not receive any supplementation, and 29% received supplementation, with no significant association observed (HR, 1.044; 95% CI: 0.913-1.193, P=0.53). To conclude, in patients diagnosed with moderate concomitant aortic and mitral valve disease, the use of calcium and vitamin D supplements was associated with a greater mortality rate, particularly in AS patients.