Role of vitamin D supplementation in prevention of new onset atrial fibrillation in post-coronary artery bypass graft patients in vitamin D deficient and insufficient populations: a systematic review and meta-analysis.

BACKGROUND

Postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting (CABG), contributing to increased morbidity, prolonged hospitalization, and elevated healthcare costs. Emerging evidence suggests that vitamin D (Vit. D), via its anti-inflammatory effects and modulation of the renin-angiotensin-aldosterone system (RAAS), may have a cardioprotective role.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the efficacy of preoperative Vit. D supplementation in reducing the incidence of POAF among CABG patients, with a focus on populations with Vit. D deficiency and insufficiency.

METHODS

Our study was conducted in accordance with the PRISMA 2020 Guidelines. The electronic databases PubMed, Cochrane Library and Google Scholar were searched from 2014 to 2024. Randomized controlled trials and retrospective observational studies involving adult subjects, evaluating Vit. D deficient and/or insufficient patients who have undergone CABG and received Vit. D supplementation in addition to standard care, compared to patients receiving standard care alone or with placebo, and reporting incidence of new-onset POAF were included. Statistical analysis was performed using RevMan v5.4 software, utilizing a random effects model with heterogeneity assessed using the I2 statistic.

RESULTS

A total of four randomized controlled trials were included in our study, evaluating a sample size of 694 (Vitamin D group- 342, Control group- 352; mean age- 61.8 years, 42.6% females). Our meta-analysis revealed that preoperative Vit. D supplementation significantly reduced the incidence of POAF in post-CABG patients with sub-optimal Vit. D levels (RR = 0.55, 95% CI: 0.40-0.76, p = 0.0003, I2 = 1%). However, no significant effect was noted in the Vit. D insufficient population. Supplementation did not significantly affect length of hospital stay (MD = -0.62, 95% CI: -0.74-0.50, p = 0.28) or duration of intubation (MD = 0.00, 95% CI: -0.26-0.26, p = 0.99).

CONCLUSION

Preoperative Vit. D supplementation appears beneficial in reducing POAF risk in deficient CABG patients, but not in insufficient populations. These findings support targeted supplementation as a potential adjunct in perioperative care, though further large-scale studies are warranted to define optimal dosing strategies and broader applicability.