INTERNATIONAL STROKE CONFERENCE 2020 POSTER ABSTRACTS
SESSION TITLE: PREVENTIVE STRATEGIES II
Pamela M Rist, Nancy R Cook, JoAnn E Manson, Julie E Buring, Kathryn M Rexrode
Too small of doses of VItamin D amd Omega-3
- Overview Stroke and vitamin D
- Stroke incidence not associated with low Vitamin D (but stroke outcome is) – Aug 2019
- Resveratrol improves health (Vitamin D receptor, etc.)
- Resveratrol can increase the amounf of Vitamin D in blood which acually gets to the cells
- Stroke risks increased if low Vitamin D: Death 3.6 X, recurrence 5.5 X – Meta-analysis Nov 2019
- Ischemic Stroke risk reduced by 2.5 if have good level of vitamin D – meta-analysis Feb 2018
- Vitamin D associated with 50 percent less ischemic stroke – meta-analysis Aug 2012
- Cerebrovascular disease 40 percent less likely if high level of vitamin D – meta-analysis Sept 2012
- 50 percent fewer strokes with vitamin D, even though ignored dose size – meta-analysis March 2012
- Stroke patients getting weekly 50,000 IU Vitamin D did better – trial March 2021
- Stroke not prevented by just 2,000 IU of vitamin D plus 840 mg Omega-3 (VITAL) – Feb 2020
- Stroke patients need more than 2,000 IU of vitamin D (found this time in Japan) – RCT June 2019
- Improved recovery from ischemic stroke with Vitamin D (300,000 IU injection) – RCT June 2018
- Ischaemic stroke – Vitamin D doubled survival (Injection followed by monthly 60,000 IU) – RCT Aug 2016
Introduction: Low serum 25-hydroxyvitamin D (25(OH)D) and low marine omega-3 fatty acid (n-3) intake are associated with increased stroke risk in observational studies. Among stroke patients, low serum 25(OH)D at admission predicts poor outcomes and animal studies suggest that higher n-3 intake may diminish brain damage in ischemic stroke. However, few studies have examined effects of vitamin D or n-3 supplements on stroke outcomes.
Hypothesis: We hypothesized that vitamin D (cholecalciferol, 2,000 IU/day) or n-3 (840 mg/day of EPA/DHA [ratio of 1.3:1]) supplementation initiated prior to stroke would reduce risk of functional limitations or physical disability after stroke compared to placebo.
Methods: We used data from the completed VITamin D and OmegA-3 TriaL (VITAL) which randomized 25,871 men aged ≥50 years and women aged ≥55 years without cardiovascular disease or cancer at baseline and followed them for incident events over 5.3 years. Individuals experiencing a stroke were mailed a questionnaire to assess functional limitations (with the physical performance scale adapted from Nagi) and physical disability (with the modified Katz Activities of Daily Living and Rosow-Breslau Functional Health scales). We used logistic regression to analyze associations between randomized treatment assignments and limitations on each scale.
Results: 290 individuals experienced their first stroke during the trial (including 42 fatal strokes). 197 stroke survivors completed the stroke outcomes questionnaire a mean of 1.6 years after diagnosis. We observed no associations between randomized treatment to vitamin D and functional limitations (odds ratio (OR)=1.01, 95% confidence interval (CI): 0.52, 1.97) or physical disability on the Rosow-Breslau (OR=1.03, 95% CI: 0.31, 3.42) or Katz (OR=0.92, 95% CI: 0.50, 1.67) scales.
Although not statistically significant, those randomized to n-3 had
- lower risk of functional limitations (OR=0.55, 95% CI: 0.28, 1.09) and
- physical disability on the Katz scale (OR=0.32, 95% CI: 0.50, 1.67)
- but not on the Rosow-Breslau scale (OR=1.03, 95% CI: 0.31, 3.42).
Conclusion: Supplementation with vitamin D or omega-3 fatty acids prior to stroke did not result in significantly improved outcomes after stroke among older individuals.