Continuing Education: Therapeutics The Journal of Clinical Pharmacology 2018, 58(2) 144–151 C  2017, The American College of Clinical Pharmacology DOI: 10.1002/jcph.989 Effect of Vitamin D in the Prevention of Myocardial Injury Following Elective Percutaneous Coronary Intervention: A Pilot Randomized Clinical Trial Naser Aslanabadi, MD 1 , Iraj Jafaripor, MD 2 , Selda Sadeghi, PharmD 3 , Hadi Hamishehkar, PharmD 3 , Samad Ghaffari, MD 1 , Mehdi Toluey, MD 1 , Hanieh Azizi, PharmD 3 , and Taher Entezari-Maleki, PharmD 1,3 Abstract Myocardial injury following elective percutaneous coronary intervention (PCI) occurs in about one-third of patients and is associated with mortality. Platelet aggregation, thrombosis formation, and infammation are the main causes of cardiac injury during PCI. Vitamin D plays a key role in the cardiovascular system by exerting antiplatelet, anticoagulant, and anti-infammatory properties. There is no published study that investigated the effect of vitamin D in the prevention of cardiac injury following elective PCI. In a randomized clinical trial, 99 patients admitted for elective PCI were randomized into vitamin D (n = 52) and control (n = 47) groups.The intervention group received 300 000 IU vitamin D orally 12 hours before PCI. The cardiac biomarkers were checked at baseline, 8 and 24 hours after PCI. hs-CRP was also measured at baseline and after 24 hours. The increase in CK-MB was documented in 20 patients (42%) in the control group and 18 patients (34.6%) in the intervention group (P = .417). Furthermore, the increase in cTnI occurred in 4 patients (8%) and 2 patients (3.3%) in the control and intervention groups, respectively (P = .419). No signifcant changes were noted in the level of cardiac biomarkers. In the vitamin D group, the mean difference in CK-MB between 8 and 24 hours was signifcantly lower (P = .048). The mean difference in hs-CRP was signifcantly lower in the vitamin D group (P = .045). This study could not show a clear effect of vitamin D in the prevention of cardiac injury during elective PCI. Further outcome-based studies are needed to describe the role of vitamin D in the prevention of periprocedural myocardial injury. Keywords vitamin D, percutaneous coronary intervention, periprocedural myocardial injury, CK-MB, cTnI, hs-CRP Percutaneous coronary intervention (PCI) is an im- portant procedure in the management of occlusive coronary artery disease. 1,2 Despite the known safety and minimally invasive nature of the procedure, it may result in cardiac injury in about one-third of patients undergoing elective PCI and infuence patients’ outcomes. 3–5 American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines have also focused on periprocedural myocardial injury (PMI) and recommended the check of cardiac biomarkers following PCI for outcome assessment. 6 Based on the 2012 Joint ESC/ACCF/AHA/WHF Task Force on the third universal defnition of my- ocardial infarction (MI), the rising cardiac biomarkers above the 99th percentile upper limit of normal (ULN) following elective PCI was defned as PCI-related my- ocardial injury. Furthermore, the raising of cardiac troponins above 5 times the 99th percentile ULN along with ischemic, radiographic, or imaging fndings was defned as PCI-related MI or type 4a MI. 6 Commonly, PMI occurs because of embolization of thrombotic plaque, platelet aggregation, thrombosis formation, coronary artery vasospasm, oxidative stress, and infammation. 5 Based on recent data, a low level of vitamin D is as- sociated with increased risk of cardiovascular diseases and mortality. 7–11 It was suggested that vitamin D may be involved in the pathogenesis of cardiovascular dis- ease by exerting anti-infammatory and antithrombotic 1 Cardiovascular Research Center,Tabriz University of Medical Sciences, Tabriz, Iran 2 Department of Cardiology, Babol University of Medical Sciences, Babol, Iran 3 Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Submitted for publication 27 March 2017; accepted 29 June 2017. Corresponding Author: Taher Entezari-Maleki, PharmD, Clinical Pharmacy Specialist, Assistant Professor of Clinical Pharmacy, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Email: tentezari@gmail.com