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25-Hydroxyvitamin D and symptomatic ischemic stroke: An Original Study and Meta-Analysis - 2012
Ann Neurol. 2012 Aug 25. doi: 10.1002/ana.23738.
Brøndum-Jacobsen P, Nordestgaard BG, Schnohr P, Benn M.
Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital; Faculty of Health and Medical Sciences, University of Copenhagen.
OBJECTIVE: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population.
METHODS: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen City Heart Study.
During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively.
In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events.
RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D concentrations between the 1st and 4th percentiles to individuals with 25-hydroxyvitamin D concentrations between the 50th and 100th percentiles, multivariate adjusted hazard ratio of ischemic stroke was 1.82 (95% confidence interval, 1.41-2.34).
Comparing individuals with clinical categories of severe vitamin D deficiency (<25.0nmol/l [<10.0ng/ml]) to individuals with optimal vitamin D status (≥75.0nmol/l [≥30.0ng/ml]), the multivariate adjusted hazard ratio of ischemic stroke was 1.36 (1.09-1.70). 25-Hydroxyvitamin D concentrations were not associated with risk of hemorrhagic stroke.
In a meta-analysis comparing lowest versus highest quartile of 25-hydroxyvitamin D concentrations, the multivariate adjusted odds ratio of ischemic stroke was 1.54 (1.43-1.65) with a corresponding hazard ratio of 1.46 (1.35-1.58) in prospective general population studies.
INTERPRETATION: In this large population-based prospective study, we observed stepwise increasing risk of symptomatic ischemic stroke with decreasing plasma 25-hydroxyvitamin D concentrations. This finding was substantiated in a meta-analysis. ANN NEUROL 2012.
Copyright © 2012 American Neurological Association.
PMID: 23225498
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