Lower Vitamin D Status Is Associated with an Increased Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis

Zhou, Ren; Wang, Meng-Ying; Huang, Hui; Li, Wenyong; Hu, Yonghua; Wu, Tao

doi:10.3390/nu10030277

Cited by 97 publications

(85 citation statements)

References 40 publications

(35 reference statements)

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“…A logistic regression analysis revealed independence of vitamin D in the disease status where vitamin D insufficiency increases the risk of stroke severity by 2.884 times whereas vitamin D deficiency increases the severity 13.78 times. These findings came in agreement with Makariou and colleagues [6], also Zhou and colleagues [5]. Another logistic regression analysis was done to evaluate the independence of vitamin D in the disease outcome.…”

Section: Discussionsupporting

confidence: 87%

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Vitamin D status in acute ischemic stroke: relation to initial severity and short-term outcome

Fahmy

Sharaf

Helmy

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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Background: A growing body of evidence indicated that vitamin D has a potential protective role against neurovascular injury. Low serum vitamin D has been associated with increased risk for incident stroke and stroke fatality.Objective: This study aimed to investigate vitamin D status among acute ischemic stroke patients and examine its relation to initial severity and short-term outcome. Subjects and methods: Forty-eight acute ischemic stroke patients and 48 matched healthy control subjects participated in the study. Subjects were divided according to vitamin D level into deficient, insufficient, and sufficient groups. National Institute of Health Stroke Scale (NIHSS) on admission and after 72 h and modified Rankin Scale (mRS) on discharge and after 3 months were performed for all patients. Results: Stroke patients had significantly lower serum vitamin D levels compared to healthy subjects. Vitamin D deficiency and insufficiency were significantly prevalent among patients compared to healthy controls. Significant negative correlation was detected between serum vitamin D and NIHSS scores on admission and after 72 h. Significant negative correlation was also detected between serum vitamin D and mRS scores on discharge and after 3 months. An increased risk of stroke of 2.88 times was found in patients with insufficient vitamin D in comparison to sufficient subgroup, and this likelihood increases to be 13.78 times in the deficient compared to sufficient subgroups. Conclusion: Vitamin D deficiency increases the risk of acute ischemic stroke and is associated with increased initial stroke severity and worse short-term outcome.

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Section: Discussionsupporting

confidence: 87%

“…Large epidemiological studies indicated an association between vitamin D status and risk of stroke [5]. However, the relationship between different vitamin D states in acute ischemic stroke patients as well as exploring vitamin D as an independent risk factor for acute ischemic stroke need more elucidation [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Vitamin D status in acute ischemic stroke: relation to initial severity and short-term outcome

Fahmy

Sharaf

Helmy

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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“…As a neurosteroid, vitamin D plays a vital role in preventing vascular injury through the mechanism of inhibiting the renin-angiotensin-aldosterone system and atherogenesis [7], lowering blood pressure, reduction in endothelial dysfunction [13], and neuroprotective actions in stroke [14]. Accumulating data have supported the hypothesis lower 25(OH)D level was associated with ischemic stroke, higher mortality and poor outcome [15][16][17][18][19][20][21][22][23][24][25][26], and a higher vitamin D was linked to a decreased risk of cerebrovascular disease [27]. These findings were also substantiated by the evidence of meta-analysis [28].…”

Section: Discussionmentioning

confidence: 99%

“…Third, we did not classify SVD into different types according to STRIVE such as lacunes, WMHs, CMBs or PVS [8,52], and we did not assess the total SVD burden (0 to 4) [10]. Further studies are required to confirm this association and explore the association among different subtypes of SVD [8,17]. Fourth, there were some different categories according to levels of vitamin D (stratified into 2 or 3 or 5) in different studies [38,53], such as deficiency (< 25 nmol/L or < 20 ng/mL), insufficiency (25-50 nmol/L or 20-30 ng/mL), sufficiency (≥50 nmol/L or ≥ 30 ng/mL) [44,54,55].…”

Section: Discussionmentioning

confidence: 99%

The combined presence of hypertension and vitamin D deficiency increased the probability of the occurrence of small vessel disease in China

Shan

et al. 2019

BMC Neurol

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Background The exact relationship between 25-hydroxyvitamin D [25(OH) D] levels and small vessel disease (SVD) are not clear in China. The aim of this study was to determine such the association between 25(OH) D and SVD in China. Methods We retrospectively enrolled 106 patients with SVD and 115 controls between Jan 2017 and Dec 2017. All the subjects were categorized into three subgroups according to the level of 25 (OH) D: vitamin D deficiency (< 12 ng/ml), insufficiency (12–20 ng/ml) and sufficiency (> 20 ng/ml). Results Among 106 SVD patients, 80 (75.5%) were men and the mean age was 61.6 ± 13.2 years. The deficiency of 25(OH) D was observed in 76 (71.7%) of SVD patients and 47 (40.9%) of controls ( P = 0.001). Compared with controls, patients with SVD were more likely to be male, a stroke history, smokers, with hyperlipidemia, higher systolic and diastolic blood pressure and low-density lipoprotein, and lower of 25(OH)D level ( P < 0.05). Logistic regression analysis revealed the level of 25 (OH) D as an independent predictor of SVD ( OR 0.772, 95% CI 0.691–0.862, P = 0.001). Compared with the sufficient 25 (OH) D group, the ORs of SVD in deficient and insufficient 25(OH)D group were 5.609 (95% CI 2.006–15.683) and 1.077 (95% CI : 0.338–3.428) after adjusting for potential confounders, respectively. In hypertensives with vitamin D deficient and insufficient group compared with sufficient group, the ORs of SVD increased to 9.738 (95% CI 2.398–39.540) and 1.108 (95% CI 0.232–5.280), respectively ( P interaction = 0.001). Conclusion We found significant associations between SVD and 25(OH)D deficiency. The combined presence of hypertension and vitamin D deficiency increased the probability of developing SVD. Our findings will warrant further prospective studies in the future.

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“…Vitamin D and risk of stroke [16,[57][58][59][60][61][62][63][64][65][66] Vitamin D and outcome of stroke [3,[11][12][13][14][15][67][68][69][70][71] Supplementation of Vitamin D and post-stroke recovery [67,72,73] Vitamin D and rehabilitation after stroke [3,[12][13][14][15]74] Appl. Sci.…”

Section: Topic Referencesmentioning

confidence: 99%

Vitamin D and Rehabilitation after Stroke: Status of Art

Siotto¹,

Santoro²,

Aprile³

2020

Applied Sciences

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Stroke is the first cause of disability in the population and post-stroke patients admitted to rehabilitation units often present a malnutrition status which can influence nutritional indices and then vitamin levels. Vitamin D deficiency seems implicated beyond stroke severity and stroke risk, and also affects post-stroke recovery. Some studies on vitamin D levels and outcome in stroke patients are available but very few data on vitamin D levels and outcome after rehabilitation treatment are reported. This literature review shows the possible relationship between vitamin D deficiency and recovery in post-stroke patients undergoing rehabilitation treatment. Moreover, because several studies have reported that single nucleotide polymorphisms and promoter methylation in genes are involved in vitamin D metabolism and might affect circulating vitamin D levels, these aspects are evaluated in the current paper. From the studies evaluated in this review, it emerges that vitamin D deficiency could not only have an important role in the recovery of patients undergoing rehabilitation after a stroke, but that genetic and epigenetic factors related to vitamin D levels could have a crucial role on the rehabilitation outcome of patients after stroke. Therefore, further studies are necessary on stroke patients undergoing rehabilitation treatment, including: (a) the measurement of the 25(OH) vitamin D serum concentrations at admission and post rehabilitation treatment; (b) the identification of the presence/absence of CYP2R1, CYP27B1, CYP24A1 and VDR polymorphisms, and (c) analysis of the methylation levels of these genes pre- and post-rehabilitation treatment.

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Lower Vitamin D Status Is Associated with an Increased Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis

Cited by 97 publications

References 40 publications

Vitamin D status in acute ischemic stroke: relation to initial severity and short-term outcome

Vitamin D status in acute ischemic stroke: relation to initial severity and short-term outcome

The combined presence of hypertension and vitamin D deficiency increased the probability of the occurrence of small vessel disease in China

Vitamin D and Rehabilitation after Stroke: Status of Art

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