Examining the Relationship Between Vitamin D Levels and Functional Values of Athletes’ Hearts with HPLC–MS/MS

A joint study between the Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Sincan Training and Research Hospital, and Hacettepe University (all located in Ankara, Turkey), exploring the relationship between vitamin D (25-hydroxyvitamin D [25(OH)D]) levels and echocardiographic parameters, assessed the association between the two using electrocardiographic (ECG) and echocardiographic evaluations in athletes. Serum 25(OH)D levels were measured using high performance liquid chromatography–tandem mass spectrometry (HPLC–MS/MS). A paper based on this research was published in Medicina (1).

Earlier papers have discussed the cardiovascular benefits of regular exercise and physical activity; these benefits include assisting in the regulation of blood pressure, controlling blood lipid levels, and increasing insulin sensitivity (2,3). Health authorities and current guidelines suggest that individuals participate in at least 150 min of moderate exercise per week; professional and recreational athletes regularly train for significantly more than those recommended levels (4). In addition to the many metabolic benefits, intense training has been known to cause specific cardiovascular adaptations, collectively known as “athlete’s heart” (5). These adaptations occur through two primary types of exercise: dynamic and static. In athletes performing dynamic exercise, a slight increase in arterial pressure is observed, alongside an increase in heart rate (HR) and cardiac output (CO) reaching up to 40 L per min (6).

Considered to be an essential nutrient, 25(OH)D is involved with multiple physiological processes, including calcium metabolism, bone health, immune function, and the regulation of cell growth and differentiation. A deficiency of 25(OH)D has been proposed as a potential risk factor for cardiovascular diseases; considering the importance of cardiovascular function in athletic performance, 25(OH)D levels may also be associated with an athlete’s cardiovascular capacity and potentially influence an individual’s endurance, oxygen utilization, and overall physical performance (7).

Previous research has proposed that deficiencies in 25(OH)D may adversely affect cardiac structure and function. Present in cardiac myocytes and fibroblasts, 25(OH)D receptors suggest a direct role in myocardial health. Studies have shown that severe 25(OH)D deficiency in athletes is associated with smaller cardiac dimensions, including reduced left ventricular mass and smaller aortic root diameters (8), which could potentially impair cardiac output and athletic performance. Furthermore, 25(OH)D deficiency has been linked to increased arterial stiffness and endothelial dysfunction as well—factors that may compromise cardiovascular efficiency during intense physical activity (9). Despite these findings, the specific impact of 25(OH)D levels on cardiac adaptations in athletes remains underexplored, inspiring the team to further investigate the relationship (1).

The case-control study included 93 male athletes, categorized into professional (n = 68) and recreational (n = 25) groups. Professional athletes were further divided into football/soccer (n = 19), weightlifting (n = 22), and running (n = 27) subgroups. Serum 25(OH)D levels were measured using LC–MS/MS, and standard 12-lead ECG and transthoracic echocardiography were performed to assess cardiac structure and function.

The data revealed that the athletes exhibited higher left ventricular interventricular septum (IVS) thickness and left ventricular posterior wall thickness (LVPWd) compared to the control group. Significant differences in diastolic function parameters, including early and late diastolic filling velocities and the early-to-late ratio, were observed among athlete subgroups. The weightlifting group showed lower end-systolic diameter (ESD) values than the football group. However, no statistically significant relationship was found between 25(OH)D levels and echocardiographic diastolic parameters. While more than half of the athletes had insufficient 25(OH)D levels (<30 ng/mL), their average values were higher than those reported in previous studies (1).

The researchers state that their data demonstrates that 25(OH)D levels do not significantly influence echocardiographic diastolic parameters in athletes. There were notable differences in structural and functional cardiac findings, however, observed among different sports disciplines. These findings contribute to the understanding of cardiac adaptations in athletes and suggest that 25(OH)D may not play a crucial role in diastolic function. It is the opinion of the researchers that additional research is needed to explore the long-term effects of 25(OH)D on athletic cardiac performance (1).

Two soccer players running and kicking a soccer ball. © matimix - stock.adobe.com

References

1. Özkan, Ö.; Yakut, İ.; Dönmez, G.; et al. Vitamin D Deficiency Does Not Impair Diastolic Function in Elite Athletes. Medicina (Kaunas) 2025, 61 (3), 407. DOI: 10.3390/medicina61030407

2. Pescatello, L. S.; Franklin, B. A.; Fagard, R.; et al. American College of Sports Medicine Position Stand. Exercise and Hypertension. Med. Sci. Sports Exerc. 2004, 36 (3), 533–553. DOI: 10.1249/01.mss.0000115224.88514.3a

3. Franklin, B. A.; Jae, S. Y. Physical Activity, Cardiorespiratory Fitness, and Atherosclerotic Cardiovascular Disease: Part 2. Pulse (Basel) 2024, 12 (1), 126–138. DOI: 10.1159/000541166

4. Alshehri, M. Enhancing Awareness of Physical Activity Guidelines Among Saudi College Students: The 150 Minutes Program. Advances in Public Health 2024, 2024 (1), 9935971. DOI: 10.1155/2024/9935971

5. Flanagan, H.; Cooper, R.; George, K.P.; et al. The Athlete’s Heart: Insights from Echocardiography. Echo Res. Pract. 2023, 10, 15. DOI: 10.1186/s44156-023-00027-8

6. Pluim, B. M.; Zwinderman, A. H.; van der Laarse, A.; et al. The Athlete’s Heart: A Meta-Analysis of Cardiac Structure and Function. Circulation 2000, 101 (3), 336–344. DOI: 10.1161/01.CIR.101.3.336

7. Haider, F.; Ghafoor, H.; Hassan, O. F.; et al. Vitamin D and Cardiovascular Diseases: An Update. Cureus 2023, 15 (11), e49734. DOI: 10.7759/cureus.49734

8. Allison, R. J.; Close, G. L.; Farooq, A.; et al. Severely Vitamin D-Deficient Athletes Present Smaller Hearts Than Sufficient Athletes. Eur. J. Prev. Cardiol. 2015, 22 (4), 535–542. 10.1177/2047487313518473

9. Chen, L.Y.; Wang, C. W.; Chen, L. A.; et al. Association of Vitamin D Deficiency with Post-Exercise Hypotension and Arterial Stiffness Following Prolonged Endurance Exercise in Healthy Young Men. J. Int. Soc. Sports Nutr. 2024, 21 (1), 2410426. DOI: 10.1080/15502783.2024.2410426