Thursday , November 23 2017
Home / Resources / Articles / Low Vitamin D Linked to Poor Health Outcomes

Low Vitamin D Linked to Poor Health Outcomes

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.)

{mainvote}

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.

Practice Pearls:

  • 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