Title: Role of 25-Hydroxy Vitamin D Level in Ischemic Stroke Patients
Authors: Arvind Kumar, Prem Singh, Gaurav Gupta, Brijesh Kumar, Mahendra Singh, S.K. Gautam, Tanu Midha Anjana Sankhwar
DOI: https://dx.doi.org/10.18535/jmscr/v9i6.01
Abstract
Background: Stroke is one of the most frequent causes of death and disability worldwide with a big significant clinical and socioeconomic impact. It has a heterogeneous etiology including unmodifiable risk factors like genetic, age, and sex, and modifiable risk factors including hypertension, diabetes mellitus, dyslipidemia, and smoking. In the recent past, studies have indicated that vitamin D deficiency is predictive for future strokes, but the evidence is limited.
Aims and Objective: To determine the role of 25-hydroxyvitamin D levels on the occurrence of ischemic stroke and its comparison with age and sex-matched controls.
Material and Methods: A case-control study was done and a total of 48 patients with acute ischemic stroke were chosen. An equal 48 controls were included in this study for the comparison of outcome. 25-hydroxy vit D levels were measured by chemiluminescence assay using commercially available kits.
Results: Mean Vitamin D Levels among cases and controls were 15.46 ±8.41 and 26.74 ± 13.28, respectively. There is a significant difference observed between the case and control group while comparing mean vitamin D levels, p-value < 0.0001 (highly significant). Vitamin D deficiency (<20 ng/ml) is inversely related to the incidence of ischemic stroke (odds ratio = 4.109 within a 95% confidence interval of 1.74 to 9.71).
Conclusion: We found that vitamin D deficiency is associated with an increased risk of ischaemic stroke.
Keywords: stroke, 25-hydroxy vitamin D,
References
- Biswas M, Sen S, Simmons J. Etiology and risk factors of ischemicstroke in Indian American patients from a hospital-based registry in New Jersey USA. Neuro Asia 2009; 14:81-86.
- World Health Organization. World Health Report 2002.Switzerland, Geneva: WHO, 2002
- Wieberdink RG, Ikram MA, Hofman A, Koudstaal PJ, Breteler MM. Trends in stroke incidence rates and stroke risk factors in Rotterdam, the Netherlands from 1990 to 2008.Eur J Epidemiol. 2012; 27:287–295. doi: 10.1007/s10654-012-9673-y.
- Chaudhuri JR, Mridula KR, Alladi S, Umamahesh M, Balaraju B, Swath A, et al. Serum 25-hydroxyvitamin D deficiency in ischemic stroke and subtypes in Indian patients. J STROKE. 2014; 16:44.
- Jemma C. HopewellRobert Clarke et al. Emerging Risk Factors for Stroke. Stroke. 2016; 47:1673–1678.
- Zhou R, Wang M, Huang H, Li W, Hu Y, Wu T. Lower vitamin D status is associated with an increased risk of ischemic stroke: a systematic review and meta-analysis. Nutrients. (2018) 10: E277. DOI: 10.3390/nu10030277.
- Turetsky A, Goddeau RP, Henninger N. Low serum vitamin D is independently associated with larger lesion volumes after ischemicstroke. J Stroke Cerebrovasc Dis. (2015) 24:1555–63. DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.051.
- Huang H, Zheng T, Wang S, Wei L, Wang Q, Sun Z. Serum 25- hydroxyvitamin D predicts early recurrent stroke in ischemic stroke patients. NutrMetab Cardiovasc Dis. (2016) 26:908–14. DOI: 10.1016/j.numecd.2016.06.009.
- Pasco JA, Henry MJ, Kotowicz MA, Sanders KM, Seeman E, Pasco JR, et al. Seasonal periodicity of serum vitamin D and parathyroid hormone, bone resorption and fractures: the Geelong Osteoporosis Study. J Bone Miner Res 2004; 19:752-758. PMID: 15068498
- Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-281. PMID: 17634462.
- Feldman D, Pike JW, Glorieux F. Vitamin D. 2nd ed. Philadelphia, PA: Elsevier (2005).
- Van Schoor, N.M.; Lips, P. Worldwide Vitamin D Status. Best Pract. Res. Clin. Endocrinol. Metab. 2011, 25, 671–680.
- Mithal, A.; Wahl, D.A.; Bonjour, J.P.; Burckhardt, P.; Dawson-Hughes, B.; Eisman, J.A.; El-Hajj Fuleihan, G.; Josse, R.G.; Lips, P.;Morales-Torres, J.; et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009, 20, 1807–1820.
- Van der Meer, I.M.; Middelkoop, B.J.; Boeke, A.J.; Lips, P. Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: An overview. Osteoporos. Int. 2011, 22, 1009–1021.
- Afzal S, Nordestgaard BG. Vitamin D, hypertension and ischemic stroke in 116 655 individuals from the general population: a genetic study. Hypertension. (2017) doi:10.1161/HYPERTENSIONAHA 117.09411.
- Pittas AG, Harris SS, Stark PC, Dawson-Hughes B. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults. Diabetes Care. (2007) 30:980–6. DOI: 10.2337/dc06-1994.
- Feng C, Tang N, Huang H, Zhang G, Qi X, Shi F. 25-Hydroxy vitamin D level is associated with total MRI burden of cerebral small vessel disease in ischemic stroke patients. Int J Neurosci. (2019) 129:49–54. DOI: 10.1080/00207454.2018.1503182.
- Wang Y, Ji H, Tong Y, Zhang ZB. Prognostic value of serum 25-hydroxyvitamin D in patients with stroke. Neurochem Res. (2014) 39:1332–7. DOI: 10.1007/s11064-014-1316-0.
- Makariou SE, Michel P, Tzoufi MS, Challa A and Milionis HJ: Vitamin D and stroke: promise for prevention and a better outcome. CurrVascPharmacol. 2014 Jan; 12(1):117-24.
- Parker GB, Brotchie H, Graham RK. Vitamin D and depression. J Affect Disord. (2017) 208:56–61. DOI: 10.1016/j.jad.2016.08.08233. Borgi L, McMullan C, Wohlhueter A, Curhan GC, Fisher ND, Forman JP. Effect of Vitamin D on endothelial function: a randomized, double-blind, placebo-controlled trial. Am J Hypertension 2017; 30:124–129. DOI: 10.1093/ajh/hpw135.
- Kienreich K, Grubler M, Tomaschitz A, Schmid J, Verheyen N, Rutters F et al. Vitamin D, arterial hypertension & cerebrovascular disease. Indian J Med Res 2013; 137: 669–679.
- Thapa L, Pokhrel B, Shrestha A, Pradhan M, Bhandari TR, Shrestha S, et al. Status of vitamin D and its association with stroke risk factors in patients with acute ischemic stroke in a tertiary care hospital. J Nepal Med Assoc. 2014; 52:935.
- Gupta A, Prabhakar S, Modi M, Bhadada SK, Lal V, Khurana D: Vitamin D status and risk of ischemic stroke in North Indian patients. Indian J Endocrinol Metab. 2014 Sep; 18(5):721-5.
- Ford L, Graham V, Wall A, Berg J. Vitamin D concentrations in a UK inner-city multicultural outpatient population. Ann Clin Biochem 2006; 43: 468–473.
- Hawkins R. Total 25-OH vitamin D concentrations in Chinese, Malays and Indians. Ann Lab Med 2013; 33: 156–158.
- Sun Q, Pan A, Hu FB, Manson JE, Rexrode KM. 25-Hydroxyvitamin D levels and the risk of stroke: a prospective study and metaanalysis. Stroke 2012; 43: 1470–1477.
- Brøndum-Jacobsen P, Nordestgaard BG, Schnohr P, Benn M. 25- hydroxyvitamin D and symptomatic ischemic stroke: an original study and meta-analysis. Ann Neuro 2013; 73: 38–47.
- Michos ED, Reis JP, Post WS, Lutsey PL, Gottesman RF, Mosley TH et al. 25(OH)D deficiency is associated with fatal stroke among whites but not blacks: the NHANES-III linked mortality files. Nutrition 2012; 28: 367–371.
- Robinson-Cohen C, Hoofnagle AN, Ix JH, Sachs MC, Tracy RP, Siscovick DS et al. Racial differences in the association of serum 25- hydroxyvitamin D concentration with coronary heart disease events. JAMA 2013; 310: 179–188.
- Kenneth E. S. Poole, Nigel Loveridge, Peter J. Barker, David J. Halsall, Collette Rose, Jonathan Reeve and Elizabeth A. Warburton; Reduced Vitamin D in Acute Stroke; stroke AHA journal.
- Majumdar V, Prabhakar P, Kulkarni GB, Christopher R: Vitamin D status, hypertension and ischemic stroke: a clinical perspective. J Hum Hypertension. 2015 Nov; 29(11):669-74.
- Abolfazl Talebi, Alireza Amirabadizadeh, Samaneh Nakhaee, Zahra madi and Seyed Mohammad Mousavi-Mirzaei: Cerebrovascular disease: how serum phosphorus, vitamin D and uric acid levels contribute to the ischemic stroke; BMC Neurology (2020) 20:116
- Fahmy, E., Sharaf, S., Helmy, H. et al. Vitamin D status in acute ischemic stroke: relation to initial severity and short-term outcome.Egypt J Neuro-Psychiatry Neurosurgery 55, 18 (2019).