Design and rationale of a multicentre, randomised, double-blind, placebo-controlled clinical trial to evaluate the effect of vitamin D on ventricular remodelling in patients with anterior myocardial infarction: the VITamin D in Acute Myocardial Infarction (VITDAMI) trial

José Tuñón, Ignacio González-Hernández, Lucía Llanos-Jiménez, Joaquín Alonso-Martín, Juan M Escudier-Villa, Nieves Tarín, Carmen Cristóbal, Petra Sanz, Ana M Pello, Álvaro Aceña, Rocío Carda, Miguel Orejas, Marta Tomás, Paula Beltrán, Marta Calero Rueda, Esther Marcos, José María Serrano-Antolín, Carlos Gutiérrez-Landaluce, Rosa Jiménez, Jorge Cabezudo, Alejandro Curcio, Germán Peces-Barba, Emilio González-Parra, Raquel Muñoz-Siscart, María Luisa González-Casaus, Antonio Lorenzo, Ana Huelmos, Javier Goicolea, Borja Ibáñez, Gonzalo Hernández, Luis M Alonso-Pulpón, Jerónimo Farré, Óscar Lorenzo, Ignacio Mahíllo-Fernández, Jesús Egido, José Tuñón, Ignacio González-Hernández, Lucía Llanos-Jiménez, Joaquín Alonso-Martín, Juan M Escudier-Villa, Nieves Tarín, Carmen Cristóbal, Petra Sanz, Ana M Pello, Álvaro Aceña, Rocío Carda, Miguel Orejas, Marta Tomás, Paula Beltrán, Marta Calero Rueda, Esther Marcos, José María Serrano-Antolín, Carlos Gutiérrez-Landaluce, Rosa Jiménez, Jorge Cabezudo, Alejandro Curcio, Germán Peces-Barba, Emilio González-Parra, Raquel Muñoz-Siscart, María Luisa González-Casaus, Antonio Lorenzo, Ana Huelmos, Javier Goicolea, Borja Ibáñez, Gonzalo Hernández, Luis M Alonso-Pulpón, Jerónimo Farré, Óscar Lorenzo, Ignacio Mahíllo-Fernández, Jesús Egido

Abstract

Introduction: Decreased plasma vitamin D (VD) levels are linked to cardiovascular damage. However, clinical trials have not demonstrated a benefit of VD supplements on left ventricular (LV) remodelling. Anterior ST-elevation acute myocardial infarction (STEMI) is the best human model to study the effect of treatments on LV remodelling. We present a proof-of-concept study that aims to investigate whether VD improves LV remodelling in patients with anterior STEMI.

Methods and analysis: The VITamin D in Acute Myocardial Infarction (VITDAMI) trial is a multicentre, randomised, double-blind, placebo-controlled trial. 144 patients with anterior STEMI will be assigned to receive calcifediol 0.266 mg capsules (Hidroferol SGC)/15 days or placebo on a 2:1 basis during 12 months.

Primary objective: to evaluate the effect of calcifediol on LV remodelling defined as an increase in LV end-diastolic volume ≥10% (MRI).

Secondary objectives: change in LV end-diastolic and end-systolic volumes, ejection fraction, LV mass, diastolic function, sphericity index and size of fibrotic area; endothelial function; plasma levels of aminoterminal fragment of B-type natriuretic peptide, galectin-3 and monocyte chemoattractant protein-1; levels of calcidiol (VD metabolite) and other components of mineral metabolism (fibroblast growth factor-23 (FGF-23), the soluble form of its receptor klotho, parathormone and phosphate). Differences in the effect of VD will be investigated according to the plasma levels of FGF-23 and klotho. Treatment safety and tolerability will be assessed. This is the first study to evaluate the effect of VD on cardiac remodelling in patients with STEMI.

Ethics and dissemination: This trial has been approved by the corresponding Institutional Review Board (IRB) and National Competent Authority (Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)). It will be conducted in accordance with good clinical practice (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use - Good Clinical Practice (ICH-GCP)) requirements, ethical principles of the Declaration of Helsinki and national laws. The results will be submitted to indexed medical journals and national and international meetings.

Trial registration number: NCT02548364; Pre-results.

Keywords: Vitamin D; acute myocardial infarction; calcifediol; cardiac magnetic resonance imaging; remodeling.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Flow chart of the VITDAMI trial. (1) Only at Fundación Jiménez Díaz. STEMI, ST-elevation myocardial infarction; VITDAMI, VITamin D in Acute Myocardial Infarction.

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