Background and Purpose-Vitamin D deficiency is common among the elderly and may contribute to cerebrovascular diseases. We aimed to elucidate whether low vitamin D levels are predictive for fatal stroke. 4 In cross-sectional analyses, hemiplegic patients with acute stroke showed significantly reduced 25(OH)D concentrations compared with healthy controls. 5 Data from a population-based study showed that elderly persons with a low intake of vitamin D and low serum concentrations of 1,25(OH)2D were at increased risk for future strokes even after adjustment for age, sex, smoking, and functional capacity. 6 We aimed to extend the currently rare knowledge about vitamin D and stroke by addressing the question whether low levels of 25(OH)D and 1,25(OH)2D are predictive for fatal stroke in patients from the LURIC study.
Methods-The
Subjects and MethodsA detailed description of the baseline examinations of the LURIC study has been published elsewhere. 7 In brief, the LURIC study is a prospective cohort study of 3316 white patients who were routinely referred to coronary angiography at a single tertiary center in southwestern Germany. All study participants gave their informed consent, and the ethics committee at the Á rztekammer RheinlandPfalz approved the study. Previous cerebrovascular disease (CVD) events were defined as a documented history of a foregoing transient ischemic attack, prolonged ischemic deficit, or cerebral infarction with or without a remaining neurologic deficit. 7 25(OH)D was determined in serum samples by radioimmunoassay (RIA) (DiaSorin Antony, France; Stillwater, Minn, USA) with an intra-assay and interassay coefficient of variation of 8.6% and 9.2%, respectively. In 100 randomly chosen samples, we determined 25(OH)D by liquid (Tables 2 and 3). These odds ratios remained significant after adjustments for cardiovascular risk factors, physical activity level, and calcium and parathyroid hormone levels (Tables 2 and 3). At baseline, 274 patients had a history of previous CVD events. In age-and sex-adjusted binary logisticregression analyses including the entire LURIC cohort (survivors and all deceased patients), the odds ratios per z value were 0.76 (
DiscussionIn a cohort of Ͼ3000 patients referred to coronary angiography, low levels of 25(OH)D and 1,25(OH)2D were independent predictors for fatal stroke and were reduced in patients with a history of previous CVD events at baseline. In particular, patients after acute stroke are at increased risk for vitamin D insufficiency due to reduced sun exposure and low dietary intake. 8 Vitamin D supplementation in stroke patients has already been shown to reduce osteopenia, fractures, and falls while improving muscle strength. 9,10 Apart from these beneficial effects, our results suggest that vitamin D might also directly protect against stroke. This hypothesis is supported by data indicating that vitamin D may protect against hypertension, diabetes mellitus, and atherosclerosis. 2 In addition, vitamin D exerts antithrombotic and neuroprotective effects ...