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Moderate and severe strokes 2X associated with low vitamin D – 2012

Two items on this page which have virtually identical conclusion

Serum 25-hydroxyvitamin D predicts severity and prognosis in stroke patients

B. Daubail1, A. Jacquin1, J.-C. Guilland2, M. Hervieu1, G.-V. Osseby1, O. Rouaud1, M. Giroud1, Y. Béjot1 ybejot at yahoo.fr
1 Department of Neurology and Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, Dijon;, France
2 Biochimie Spécialisée, Pôle Technique de Biologie, Dijon University Hospital, Dijon, France
DOI: 10.1111/j.1468-1331.2012.03758.x
European Journal of Neurology first published online: 26 MAY 2012

We aimed to evaluate the association between 25-hydroxyvitamin D (25(OH)D) levels and both clinical severity at admission and outcome at discharge in stroke patients.

Methods
From February 2010 to December 2010, consecutive stroke patients admitted to the department of neurology of Dijon, France, were identified. Clinical information was collected. Serum concentration of 25(OH)D was measured at baseline. Stroke severity was assessed at admission using the NIHSS score. Functional impairment was evaluated at discharge using the modified Rankin scale (m-Rankin). Multivariate analyses were performed using logistic regression models.

Results
Of the 386 recorded patients, serum 25(OH)D levels were obtained in 382 (median value = 35.1 nM; IQR = 21–57.8). At admission, 208 patients had a NIHSS ?5, with a higher mean 25(OH)D level than that observed in patients with moderate-to-high severity (45.9 vs. 38.6 nM, P < 0.001). In multivariate analyses, a 25(OH)D level in the lowest tertile (<25.7 nM) was a predictor of a NIHSS ?6 (OR = 1.67; 95% CI = 1.05–2.68; P = 0.03).

The mean 25(OH)D level was lower in patients with moderate-to-severe handicap at discharge (m-Rankin 3–6) than in patients with no or mild handicap (35.0 vs. 47.5 nM, P < 0.001).

In multivariate analyses, the lowest tertile of 25(OH)D level (<25.7 nM) was associated with a higher risk of moderate-to-severe handicap (OR = 2.06; 95% CI = 1.06–3.94; P = 0.03).

Conclusion
A low serum 25(OH)D level is a predictor of both severity at admission and poor early functional outcome in stroke patients. The underlying mechanisms of these associations remain to be investigated.
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Note: Body trauma cuts Vitamin D by half within 2 days.
Perhaps the moderate or severe strokes used up the vitamin D before measurement.
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25-hydroxyvitamin D and symptomatic ischemic stroke: an original study and meta-analysis

Peter Brøndum-Jacobsen MD1,3, Børge G. Nordestgaard MD DMSc1,3,4, Peter Schnohr MD DMSc4, Marianne Benn MD PhD DMSc1,2,3,†,*
DOI: 10.1002/ana.23738
Annals of Neurology

Background:
We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D associate with increased risk of symptomatic ischemic stroke in the general population.

Methods:
We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke. In a meta-analysis of ischemic stroke we included ten studies, 58,384 participants, and 2,644 events.

Results:
Stepwise decreasing plasma 25-hydroxyvitamin D concentrations were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D(p for trend?2×10?6). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D concentrations between the 1st-4th percentile to individuals with 25-hydroxyvitamin D concentrations between the 50th-100th percentile, multivariable adjusted hazard ratio of ischemic stroke was 1.82(95% confidence interval: 1.41-2.34). Comparing individuals with clinical categories of severe vitamin D deficiency (<25.0nmol/L(<10.0ng/mL)) to individuals with optimal vitamin D status (?75.0nmol/L(?30.0ng/mL)), the multivariable adjusted hazard ratio of ischemic stroke was 1.36(1.09-1.70). 25-hydroxyvitamin D concentrations were not associated with risk of hemorrhagic stroke. In a meta-analysis comparing lowest versus highest quartile of 25-hydroxyvitamin D concentrations, the multivariable adjusted odds ratio of ischemic stroke was 1.54(1.43-1.65) with a corresponding hazard ratio of 1.46(1.35-1.58) in prospective general population studies.

Interpretation:
In this large population-based prospective study, we observed stepwise increasing risk of symptomatic ischemic stroke with decreasing plasma 25-hydroxyvitamin D concentrations. This finding was substantiated in a meta-analysis. Ann Neurol 2012.
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See also VitaminDWiki

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