Overview Stroke and vitamin D

Summary - as with many other diseases,

  • 2000+ IU of vitamin D will provide some stroke prevention
  • 10,000+ IU of vitamin D will provide some treatment and prevention
  • need more if in a high risk group
    • examples include elderly, dark skin, live from from equator, obese, avoid the sun, ...

Stroke mortality 3X worse among seniors with less than 26 ng of vitamin D – June 2014


Stroke Incidence Increasing Among Children And Young Adults, USA Medical News today, Sept 2011

In Annals of Neurology., researchers found that over the period 1995-1996 to 2007-2008:
Ischemic stroke incidence rose 50% among males aged 35 to 44 years
Ischemic stroke incidence rose 46% among males aged 15 to 34.
Ischemic stroke incidence rose 51% among boys aged 5 to 14.
no mention of vitamin D

Rising Incidence of Stroke Among Young Adults

Reporting on Christine Fox, MD, MAS reviewing Kissela BM et al. Neurology 2012 Oct 23.
The stroke incidence among adults aged 20 to 54 increased substantially during a 12-year period in a population-based study.
For aged 20 through 54 from 1993–1994 ==> 2005 incidence rate per 100,000

  • Blacks 83 ==> 128
  • Whites 26 ==> 48

no mention of vitamin D

New Study Shows Lack of this Vitamin Linked to Strokes Mercola Jan 2011

comment on American Heart Association's (AHA) Annual Scientific Sessions, Chicago, IL November 15, 2010
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Not only is vitamin D known to help reduce your risk of arterial stiffness, a major risk factor for stroke, but it can also:

  • Increase in your body's natural anti-inflammatory cytokines
  • Suppress vascular calcification
  • Inhibit vascular smooth muscle growth

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Hypertension (blood pressure) increases incidence of strokes

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See also at VitaminDWiki

Article about Brigham Women's Hospital Study which was published in Stroke
"women with a history of depression had a 29 percent higher risk of stroke, even after considering other stroke risk factors."
"The study included more than 80,000 female nurses between the ages of 54 to 79 years old from 2000-06 without a prior history of stroke. "
"More than 1000 cases of stroke were documented among the women during the six years."
CLICK HERE for abstract Aug 2011
(VitaminDWiki notices that the principal author has published many other papers on cardiovascular problems and low vitamin D levels. Kathryn M. Rexrode krexrode at partners.org)

Stroke patients with low vitamin D were 10X more likely to become depressed – Aug 2014

Stroke patients with low vitamin D were 10X more likely to become depressed – Aug 2014

The effect of vitamin D replacement on markers of vascular health in stroke patients - A randomised controlled trial.

Nutr Metab Cardiovasc Dis. 2010 Dec 29. [Epub ahead of print]
Witham MD, Dove FJ, Sugden JA, Doney AS, Struthers AD.
Ageing and Health, Centre for Cardiovascular and Lung Biology, Division of Medicine, University of Dundee, Dundee DD1 9SY, UK.

BACKGROUND AND AIMS: Low vitamin D levels are associated with increased incidence of future cardiovascular events and are common in stroke patients. We tested whether vitamin D supplementation could reduce blood pressure and improve markers of vascular health in patients who had previously suffered a stroke.

METHODS AND RESULTS: Randomised, placebo-controlled, double-blind trial. Community-dwelling patients with a history of stroke and baseline 25-hydroxyvitamin D levels <75 nmol/L received 100,000 units of oral vitamin D2 or placebo at baseline. Office and 24 h blood pressure, endothelial function measured by flow-mediated dilatation of the brachial artery, cholesterol, oxidised low density lipoprotein, B-type natriuretic peptide and heart rate turbulence were measured at baseline, 8 weeks and 16 weeks. 58 patients were randomised. Mean age was 67 years, mean baseline blood pressure 128/72 mmHg, mean baseline 25-hydroxyvitamin D level was 38 nmol/L. Serum 25-hydroxyvitamin D levels were higher in the intervention group at 8 weeks compared to placebo (54 vs 42 nmol/L, P = 0.002) and remained higher at 16 weeks. Office systolic and diastolic blood pressure showed no significant change between groups at 8 weeks (systolic 126.1 vs 131.3 mmHg; adjusted P = 0.97); (diastolic 73.1 vs 74.9 mmHg, adjusted P = 0.15). Flow mediated dilatation was significantly higher in the intervention group at 8 weeks (6.9% vs 3.7%, adjusted P = 0.007) but was not significantly different at 16 weeks.

CONCLUSIONS: High dose oral vitamin D supplementation did not improve blood pressure but produced short-term improvement in endothelial function in stroke patients with well-controlled baseline blood pressure. Clinical trials registration: ISRCTN28737567.
Copyright © 2010 Elsevier B.V. All rights reserved. PMID: 21194910
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Vitamin D deficiency and stroke: time to act!

Am J Cardiol. 2010 Dec 1;106(11):1674.
Pilz S, Tomaschitz A, März W.
Comment on: Am J Cardiol. 2010 Oct 1;106(7):963-8. ; PMID: 21094375

Low vitamin d levels predict stroke in patients referred to coronary angiography.

Pilz S, Dobnig H, Fischer JE, Wellnitz B, Seelhorst U, Boehm BO, März W.
Stroke. 2008 Sep;39(9):2611-3. Epub 2008 Jul 17.
Synlab Center of Laboratory Diagnostics, Heidelberg, PO Box 10470, D-69037 Heidelberg, Germany.
Comment in: * Stroke. 2009 Feb;40(2):e36; author reply e37-8.; * Stroke. 2009 Feb;40(2):e35; author reply e37-8.

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.

METHODS: The LUdwigshafen RIsk and Cardiovascular Health (LURIC) study includes 3316 patients who were referred to coronary angiography at baseline between 1997 and 2000. 25-Hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] were measured in 3299 and 3315 study participants, respectively.
To account for the seasonal variation of vitamin D metabolites, we calculated z values for the 25(OH)D and 1,25(OH)2D concentrations within each month of blood draw.

RESULTS: During a median follow-up time of 7.75 years, 769 patients died, including 42 fatal (ischemic and hemorrhagic) strokes. When compared with survivors in binary logistic-regression analyses, the odds ratios (with 95% CIs) for fatal stroke were 0.58 (0.43 to 0.78; P<0.001) per z value of 25(OH)D and 0.62 (0.47 to 0.81; P<0.001) per z value of 1,25(OH)2D. After adjustment for several possible confounders, these odds ratios remained significant for 25(OH)D at 0.67 (0.46 to 0.97; P=0.032) and for 1,25(OH)2D at 0.72 (0.52 to 0.99; P=0.047). Z values of 25(OH)D and 1,25(OH)2D were also reduced in the 274 patients who had a history of previous cerebrovascular disease events at baseline.

CONCLUSIONS: Low levels of 25(OH)D and 1,25(OH)2D are independently predictive for fatal strokes, suggesting that vitamin D supplementation is a promising approach in the prevention of strokes. PMID: 18635847 CLICK HERE for PDF

VitaminDWiki: It appears that patients were 30% more likely to have FATAL stroke if have coronary angiogram and low on vitamin D

Strokes occur 25% more often in the Spring - when the vitamin D blood levels are the lowest

Incidence of Stroke and Season of the Year: Evidence of an Association
Am J Epidemiol 2000;152:558–64.
1. Ann L. Oberg 1 , 2 , 3 ,
2. Jeffery A. Ferguson 4 , 5 ,
3. Lauren M. McIntyre 2 , 6 , 7 , 8 and
4. Ronnie D. Horner 2 , 6 , 9

Evidence of seasonal variation in the incidence of stroke is inconsistent. This may be a likely consequence of one or more methodological shortcomings of the studies investigating this issue, including inappropriate analytic models, insufficient length of time, small sample size, and a regional (vs. national) focus. The authors' objective was to ascertain whether an association exists between season of the year and the incidence of stroke by using a methodological approach designed to overcome these limitations.
The authors used a longitudinal study design involving 72,779 veterans hospitalized for stroke at any Veterans Affairs hospital nationally during the years 1986–1995.
These data were analyzed by using time series methods.
There was clear evidence of a seasonal occurrence for stroke in general.
This seasonal effect was found for ischemic stroke, but not for hemorrhagic stroke.
The peak occurrence was in mid-May.
Neither the region (i.e., climate) nor the race of the patient substantially modified the seasonal trend. An explanation for this pattern remains to be determined.

Higher Stroke Incidence in the Spring Season Regardless of Conventional Risk Factors

Takashima Stroke Registry, Japan, 1988–2001
(Stroke. 2008;39:745.) © 2008 American Heart Association, Inc.
Tanvir Chowdhury Turin, MBBS; Yoshikuni Kita, PhD; Yoshitaka Murakami, PhD; Nahid Rumana, MBBS; Hideki Sugihara, MD; Yutaka Morita, MD; Nobuyoshi Tomioka, MD; Akira Okayama, MD; Yasuyuki Nakamura, MD; Robert D. Abbott, PhD; Hirotsugu Ueshima, MD
From Department of Health Science (T.C.T., Y.K., Y.M., N.R., R.D.A., H.U.), Shiga University of Medical Science, Otsu, Shiga, Japan; Department of Internal Medicine (H.S.), Takashima General Hospital, Takashima, Japan; Makino Hospital (Y.M.), Takashima, Japan; Department of Cardiology (N.T.), Otsu Red Cross Hospital, Otsu, Shiga, Japan; Department of Preventive Cardiology (A.O.), National Cardiovascular Center, Suita, Osaka, Japan; Kyoto Women’s University (Y.N.), Kyoto, Japa; Division of Biostatistics and Epidemiology (R.D.A.), University of Virginia, School of Medicine, Charlottesville, Va.
Correspondence to Tanvir Chowdhury Turin, Department of Health Science, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City, Shiga, 520-2192, Japan. E-mail turin at belle.shiga-med.ac.jp or dr.turin at gmail.com

Background and Purpose— Seasonal variation in stroke incidence was examined using 14-year stroke registration data in a Japanese population.
We also examined if this variation was modified by conventional stroke risk factors hypertension, diabetes mellitus, drinking, and smoking.

Methods— Data were obtained from the Takashima Stroke Registry, which covers a stable population of {approx}55 000 in Takashima County in central Japan. There were 1665 (men, 893; women, 772) registered first-ever stroke cases during 1988 to 2001. The average age of stroke onset for men and women patients was 69.4 and 74.2 years, respectively. Incidence rates (per 100 000 person-years) and 95% CI were calculated by gender, age, and stroke subtype for winter, spring, summer, and autumn. After stratifying patients by their risk factor history, the OR (with 95% CI) of having a stroke in autumn, winter, and spring were calculated, with summer serving as a reference.

Results— Among the seasons, stroke incidence per 100 000 person-years was highest in the spring (231.3; 95% CI, 211.1 to 251.5). Spring incidence was highest in both men (240.8; 95% CI, 211.5 to 270.2) and women (222.1; 95% CI, 194.4 to 249.9), and in subjects younger than 65 years (72.6; 95% CI, 60.0 to 85.3) and 65 years or older (875.9; 95% CI, 787.5 to 964.3).
Among stroke subtypes, spring incidence was highest for cerebral infarction (154.7; 95% CI, 138.2 to 171.2)
  and cerebral hemorrhage (53.7; 95% CI, 44.0 to 63.4).
The spring excess in stroke incidence was observed regardless of the presence or absence of the risk factor histories.

Conclusions— Stroke incidence appears to be highest in the spring among a Japanese population regardless of conventional risk factor history. Factors that explain this excess need further investigation.

Image Image

Chart from a 2010 Vitamin D book edited by Dr. Holick


BBC Sept 2011 30% Increase of strokes among young in the US Vit D not mentioned

  • The rate of ischemic stroke increased by 31% in five to 14-year-olds, from 3.2 strokes per 10,000 hospital cases to 4.2 per 10,000.
  • There were increases of 30% for people aged 15 to 34 and 37% in patients between the ages of 35 and 44.
  • More than half of 35 to 44-year-olds who had an ischemic stroke also had hypertension.

Strokes in younger people worldwide 'worrying' CBC News Oct 2013

Lancet article
The commentators also called the the global increase of of 25 per cent in the incidence of stroke in those aged 25 to 64 "a worrying finding."

Magnesium in water also associated with reduction in stroke

100 mg more Magnesium in water associated with 8 percent reduction in stroke – Feb 2012
Independent evidence shows that Vitamin D and Magnesium both reduce strokes.
Expect that they would do well together - perhaps more than 2X the benefit
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Stroke 50 % more likely if low vitamin D - Meta-analysis May 2012

25-Hydroxyvitamin D Levels and the Risk of Stroke. A Prospective Study and Meta-analysis
Qi Sun, MD, ScD qisun at hsph.harvard.edu ; An Pan, PhD; Frank B. Hu, MD, PhD; JoAnn E. Manson, MD, DrPH; Kathryn M. Rexrode, MD, MPH
From the Departments of Nutrition (Q.S., A.P., F.B.H.) and Epidemiology (F.B.H., J.E.M.), Harvard School of Public Health, Boston, MA; and the Channing Laboratory (Q.S., F.B.H., J.E.M.) and the Division of Preventive Medicine (J.E.M., K.M.R.), the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

Background and Purpose—Despite evidence suggesting that vitamin D deficiency may lead to elevated cardiovascular disease risk, results regarding the association of 25-hydroxyvitamin D (25OHD) levels with stroke risk are inconclusive. We aimed to examine this association in a prospective study in women and to summarize all existing data in a meta-analysis.

Methods—We measured 25(OH)D levels among 464 women who developed ischemic stroke and an equal number of control subjects who were free of stroke through 2006 in the Nurses' Health Study (NHS). We searched MEDLINE and EMBASE for articles published through March 2011 that prospectively evaluated 25(OH)D levels in relation to stroke.

Results—After multivariable adjustment for lifestyle and dietary covariates, lower 25(OH)D levels were associated with an elevated risk of ischemic stroke in the NHS: the OR (95% CI) comparing women in the lowest versus highest tertiles was 1.49 (1.01–2.18; Ptrend=0.04). We found 6 other prospective studies that examined 25(OH)D in relation to stroke outcomes. After pooling our results with these prospective studies that included 1214 stroke cases in total, low 25(OH)D levels were associated with increased risk of developing stroke outcomes in comparison to high levels: the pooled relative risk (95% CI) was 1.52 (1.20–1.85; I2=0.0%, Pheterogeneity=0.63). In 2 studies that explicitly examined ischemic stroke, this association was 1.59 (1.07–2.12; I2=0.0%, Pheterogeneity=0.80).

Conclusions—These data provide evidence that low vitamin D levels are modestly associated with risk of stroke.
Maintaining adequate vitamin D status may lower the risk of stroke in women.

Received August 22, 2011; Revision received January 24, 2012; Accepted February 9, 2012.

VitaminDWiki studies which are Stroke Meta-analysis

4X more likely to survive stroke if have high vitamin D level - May 2014

Prognostic Value of Serum 25-Hydroxyvitamin D in Patients with Stroke.
Neurochem Res. 2014 May 1. [Epub ahead of print]
Wang Y1, Ji H, Tong Y, Zhang ZB.
Author information
We aimed to evaluate the association between 25-hydroxyvitamin D [25(OH) D] levels and both clinical severity at admission and outcome at discharge in patients with acute ischemic stroke (AIS). From June 2012 to October 2013, consecutive first-ever AIS patients admitted to the Department of Emergency of The Fourth Affiliated Hospital of Harbin Medical University, China were identified. Clinical information was collected. Serum 25(OH) D levels were measured at baseline. Stroke severity was assessed at admission using the National Institutes of Health Stroke Scale (NIHSS) score. Functional outcome was evaluated at discharge using the modified Rankin scale (m-Rankin). Multivariate analyses were performed using logistic regression models. During the study period, 326 patients were diagnosed as AIS and were included in the analysis. Serum 25(OH) D levels reduced with increasing severity of stroke as defined by the NIHSS score. There was a negative correlation between levels of 25(OH) D and the NIHSS (r = - 0.389, P = 0.000). In multivariate analyses, serum 25(OH) D level was an independent prognostic marker of discharge favorable functional outcome and survival [odds ratio 3.96 (2.85-7.87) and 3.36 (2.12-7.08), respectively, P = 0.000 for both, adjusted for NHISS, other predictors and vascular risk factors] in patients with AIS. Serum 25(OH) D levels are a predictor of both severity at admission and favorable functional outcome in patients with AIS. Additional research is needed on vitamin D supplementation to improve the outcome of post-stroke patients.
PMID: 24789365

List of attached files
ID Name desc uploaded Size Downloads Actions
423 gif stroke vs season 65.gif 27 Jan., 2011 by admin 5.50 Kb 3546 View Download  
422 gif stroke vs season all.gif 27 Jan., 2011 by admin 5.42 Kb 3572 View Download  
421 gif Cardiovascular - Holick Editor 2010.gif 27 Jan., 2011 by admin 32.54 Kb 3840 View Download  
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Health Problems and D

  # of studies as of 11/24/14