{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:14:21Z","timestamp":1791951261679,"version":"4.3.4"},"reference-count":57,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010198","name":"Ministerio de Econom\u00eda, Industria y Competitividad, Gobierno de Espa\u00f1a","doi-asserted-by":"publisher","award":["SAF2016-77222-R"],"award-info":[{"award-number":["SAF2016-77222-R"]}],"id":[{"id":"10.13039\/501100010198","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Epidemiological studies suggest a relationship between vitamin D deficiency and cardiovascular and respiratory diseases. However, whether total, bioavailable, and\/or free vitamin D levels have a prognostic role in pulmonary arterial hypertension (PAH) is unknown. We aimed to determine total, bioavailable, and free 25-hydroxy-vitamin D (25(OH)vitD) plasma levels and their prognostic value in PAH patients. Methods: In total, 67 samples of plasma from Spanish patients with idiopathic, heritable, or drug-induced PAH were obtained from the Spanish PH Biobank and compared to a cohort of 100 healthy subjects. Clinical parameters were obtained from the Spanish Registry of PAH (REHAP). Results: Seventy percent of PAH patients had severe vitamin D deficiency (total 25(OH)vitD &lt; 10 ng\/mL) and secondary hyperparathyroidism. PAH patients with total 25(OH)vitD plasma above the median of this cohort (7.17 ng\/mL) had better functional class and higher 6-min walking distance and TAPSE (tricuspid annular plane systolic excursion). The main outcome measure of survival was significantly increased in these patients (age-adjusted hazard ratio: 5.40 (95% confidence interval: 2.88 to 10.12)). Vitamin D-binding protein (DBP) and albumin plasma levels were downregulated in PAH. Bioavailable 25(OH)vitD was decreased in PAH patients compared to the control cohort. Lower levels of bioavailable 25(OH)vitD (&lt;0.91 ng\/mL) were associated with more advanced functional class, lower exercise capacity, and higher risk of mortality. Free 25(OH)vitD did not change in PAH; however, lower free 25(OH)vitD (&lt;1.53 pg\/mL) values were also associated with high risk of mortality. Conclusions: Vitamin D deficiency is highly prevalent in PAH, and low levels of total 25(OH)vitD were associated with poor prognosis.<\/jats:p>","DOI":"10.3390\/jcm9020448","type":"journal-article","created":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T03:13:27Z","timestamp":1581045207000},"page":"448","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Total, Bioavailable, and Free Vitamin D Levels and Their Prognostic Value in Pulmonary Arterial Hypertension"],"prefix":"10.3390","volume":"9","author":[{"given":"Maria","family":"Callejo","sequence":"first","affiliation":[{"name":"Department of Pharmacology and Toxicology. School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IISGM), 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9514-8961","authenticated-orcid":false,"given":"Gema","family":"Mondejar-Parre\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology. School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IISGM), 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9255-7222","authenticated-orcid":false,"given":"Sergio","family":"Esquivel-Ruiz","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology. School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IISGM), 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9563-8191","authenticated-orcid":false,"given":"Miguel A.","family":"Olivencia","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology. School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IISGM), 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9028-2299","authenticated-orcid":false,"given":"Laura","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology. School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IISGM), 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Blanco","sequence":"additional","affiliation":[{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Department of Pulmonary Medicine, Hospital Cl\u00ednic-Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Escribano-Subias","sequence":"additional","affiliation":[{"name":"Department of Cardiology. 12 de Octubre University Hospital, School of Medicine, Universidad Complutense de Madrid, 28041 Madrid, Spain"},{"name":"Ciber Enfermedades Cardiovasculares (CiberCV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1382-1698","authenticated-orcid":false,"given":"Angel","family":"Cogolludo","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology. School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IISGM), 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan Albert","family":"Barbera","sequence":"additional","affiliation":[{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Department of Pulmonary Medicine, Hospital Cl\u00ednic-Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Perez-Vizcaino","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology. School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"Ciber Enfermedades Respiratorias (Ciberes), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IISGM), 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Simonneau, G., Montani, D., Celermajer, D.S., Denton, C.P., Gatzoulis, M.A., Krowka, M., Williams, P.G., and Souza, R. (2019). Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur. Respir. 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