Low vitamin D levels associated with larger brain infarct volume and worse outcomes in patients with ischemic strokes….
How helpful was this article? (Please vote.)
New findings presented at the international stroke conference (ISC) 2015 showed that lower vitamin D levels are associated with larger brain infarct volume and also worse outcomes in patients with ischemic strokes. Other population based studies have also shown links between low vitamin D levels and stroke and increased cardiovascular risk. Vitamin D affects stroke risk factors, such as hypertension and diabetes, which can in turn increase stroke risk, or cause the stroke to be more severe.
In the study, vitamin D levels were measured by 25(OH) D concentration, subsequent infarct volume, and if there was any relation to functional outcome 3 months after a CVA. The study retrospectively analyzed patients with acute ischemic stroke that were evaluated from January 2013 to January 2014 at the subjects’ tertiary referral center. All patients (n = 96) had MRI-proven acute ischemic stroke, the median age was 73 years, and 45% of patients were women. Vitamin D levels were drawn within 12 months of stroke or event. Normal vitamin D levels were defined as greater than 30 ng/mL.
Multivariable linear and logistic regression analyses were used to test whether vitamin D is an independent predictor of infarct volume and poor 90-day outcome (modified Rankin Scale [mRS] score >2). Patients with a low vitamin D level had twice the infarct volume of those with normal levels, approximately 17 vs 8 mL (P = 0.01). There was a significant association with Lacunar type strokes (P = 0.001) but no statistical significance between non-lacunar strokes.
The association between vitamin D levels and the size of infarct was only shown to be statistically significant if levels were drawn and checked during the 2 week window before the CVA occurred. This showed a 4-fold increase in diffusion-weighted lesion volume for subjects with low vitamin D levels versus subjects with normal levels (P = 0.05). When vitamin D levels were checked more randomly and outside of the 2 week window there was not a significant association between the vitamin D levels and the size of infarct. Patients with low serum concentrations of 25(OH)D were more likely to have a mRS score greater than 2. This indicates that there is some functional dependence.
Results also showed that patients who had low vitamin D levels defined as less than 30 ng/mL had about two-times larger areas of dead tissue which resulted from obstruction of the blood supply compared to patients with normal vitamin D levels. The researchers also noted that risk for poor 90-day outcome increased almost twofold for every 10-ng/mL decrease in vitamin D.
- A larger study sample size is needed.
- Since the study was retrospective, the vitamin D levels were not routinely monitored, but at the discretion of the attending physician.
- Adequate intake of vitamin D is still recommended for normal bone health.
Nils Henninger, M.D."Low vitamin D predicts more severe strokes, poor health post-stroke". American Stroke Association Meeting Report Abstract W MP62