Stroke incidence not associated with low Vitamin D (but stroke outcome is)

Vitamin D Status and Risk of Stroke -The Rotterdam Study

Stroke. 2019;50:2293–2298, https://doi.org/10.1161/STROKEAHA.119.025449

Brian P. Berghout , Lana Fani , Alis Heshmatollah , Peter J. Koudstaal , M. Arfan Ikram , M. Carola Zillikens , M. Kamran Ikram

* Stroke outcome at 3 months was 3X worse if bad stroke and low vitamin D – Jan 2020 * Death after Ischemic Stroke 2.5 X more likely if less than 10 ng of Vitamin D – May 2019 * Ischemic stroke and low vitamin D – 3X higher risk of poor outcome, 6 X higher risk of a second stroke, Oct 2017 * Stroke outcome 6.9 X worse if black and overweight (all three related via low vitamin D) – March 2018 * Depression following a stroke is 2.7 X more likely if low vitamin D – Sept 2018 * Overview Stroke and vitamin D * Stroke risks increased if low Vitamin D: Death 3.6 X, recurrence 5.5 X – Meta-analysis Nov 2019 * Stroke mortality 3X worse among seniors with less than 26 ng of vitamin D – June 2014 * Risk of some kinds of strokes areincreased if low Vitamin D * Large vessel Ischemic Stroke 13 X more likely if low vitamin D – Nov 2017 * Ischemic Stroke risk reduced by 2.5 if have good level of vitamin D – meta-analysis Feb 2018 * Deep Vein Thrombosis during ischemic stroke rehab was 4.7 X more likely if low vitamin D – July 2018 Adding Vitamin D after a stroke helps * Improved recovery from ischemic stroke with Vitamin D (300,000 IU injection) – RCT June 2018

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Background and Purpose—

Recent findings suggest that vitamin D, a neuroprotective prohormone, is involved in the pathogenesis of cardiovascular disease. However, previous studies investigating the association between vitamin D and stroke have shown inconsistent findings. In view of these discrepancies, we determined the association of vitamin D status with stroke using data from a population-based study.

Methods—

Within the RS (Rotterdam Study), an ongoing prospective population-based study, we measured serum 25-hydroxyvitamin D concentrations between 1997 and 2008 in 9680 participants (56.8% women) aged ≥45 years. We assessed a history of stroke at baseline and subsequently followed for incident stroke until January 1, 2016. Regression models were used to investigate the association of serum 25-hydroxyvitamin D with prevalent and incident stroke separately, adjusted for age, sex, study cohort, season of blood sampling, and other cardiovascular risk factors.

Results—

Of 9680 participants, 339 had a history of stroke at baseline. Serum 25-hydroxyvitamin D concentration was associated with prevalent stroke, adjusted odds ratio per SD decrease, 1.31; 95% CI, 1.14–1.51. After excluding participants with prevalent stroke, we followed 9338 participants for a total of 98 529 person-years. During follow-up, 735 participants developed a stroke. Lower serum 25-hydroxyvitamin D concentration was not associated with a higher stroke risk, adjusted hazard ratio per SD decrease, 1.06; 95% CI, 0.97–1.16. However, severe vitamin D deficiency did show a significant association: hazard ratio, 1.25; 95% CI, 1.05–1.50.

Conclusions—

In this population-based cohort, we found an association between vitamin D and prevalent stroke. Only severe vitamin D deficiency was associated with incident stroke. This suggests that lower vitamin D levels do not lead to a higher stroke risk but are instead a consequence of stroke