T Xu1,2, C Zhong1, Y Peng4, C-S Chen2, J Wang5, Z Ju6, Q Li7, D Geng8, Y Sun9, D Zhang10, Y Zhang1,2, J Chen2,12, T Xu1,2, Y Zhang1,2, J He1,2,12. 1. Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China. 2. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. 3. Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China. 4. Department of Neurology, Affiliated Hospital of Hebei United University, Hebei, China. 5. Department of Neurology, Yutian County Hospital, Hebei, China. 6. Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China. 7. Department of Epidemiology, School of Public Health, Taishan Medical College, Shandong, China. 8. Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Jiangsu, China. 9. Department of Cardiology, First Affiliated Hospital of China Medical University, Liaoning, China. 10. Department of Neurology and Cardiology, Dongping County People's Hospital, Dongping, Shandong, China. 11. Department of Neurology, Wenshang County Hospital of Traditional Chinese Medicine, Shandong, China. 12. Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
Abstract
BACKGROUND AND PURPOSE: Current observational studies indicate that a lower vitamin D level is associated with a higher risk of poor ischaemic stroke prognosis. Whether this association is affected by lipid levels is unclear. Our aim was to examine the effect of serum vitamin D especially its deficiency on the global outcome of ischaemic stroke stratified by individual lipid component level. METHODS: A total of 3181 ischaemic patients from China Antihypertensive Trial in Acute Ischaemic Stroke were included in this study and their baseline serum 25-hydroxyvitamin D levels were tested. They were prospectively followed up for death, major disability and vascular events for 3 months after acute ischaemic stroke. A multivariable logistic model was used to evaluate the association between serum 25-hydroxyvitamin D levels and clinical outcomes of ischaemic stroke in the 3-month period of follow-up in all patients and in different lipid-level subgroups. RESULTS: Vitamin D deficiency was associated with poor clinical outcomes only in ischaemic stroke patients with high density lipoprotein cholesterol (HDLC) <1.04 mmol/l rather than all patients. The multivariable adjusted odds ratios (95% confidence intervals) of major disability and composite adverse events were 1.98 (1.08-3.63) and 2.24 (1.22-4.12), respectively. There was a significant interaction effect between vitamin D and HDLC levels on major disability and the composite outcome (P for interaction < 0.05 for both). A significant linear trend existed between 25-hydroxyvitamin D and risk of poor prognosis (P = 0.03). CONCLUSIONS: Vitamin D deficiency may be merely an independent risk factor of poor prognosis in ischaemic stroke patients with low HDLC level.
RCT Entities:
BACKGROUND AND PURPOSE: Current observational studies indicate that a lower vitamin D level is associated with a higher risk of poor ischaemic stroke prognosis. Whether this association is affected by lipid levels is unclear. Our aim was to examine the effect of serum vitamin D especially its deficiency on the global outcome of ischaemic stroke stratified by individual lipid component level. METHODS: A total of 3181 ischaemic patients from China Antihypertensive Trial in Acute Ischaemic Stroke were included in this study and their baseline serum 25-hydroxyvitamin D levels were tested. They were prospectively followed up for death, major disability and vascular events for 3 months after acute ischaemic stroke. A multivariable logistic model was used to evaluate the association between serum 25-hydroxyvitamin D levels and clinical outcomes of ischaemic stroke in the 3-month period of follow-up in all patients and in different lipid-level subgroups. RESULTS:Vitamin D deficiency was associated with poor clinical outcomes only in ischaemic strokepatients with high density lipoprotein cholesterol (HDLC) <1.04 mmol/l rather than all patients. The multivariable adjusted odds ratios (95% confidence intervals) of major disability and composite adverse events were 1.98 (1.08-3.63) and 2.24 (1.22-4.12), respectively. There was a significant interaction effect between vitamin D and HDLC levels on major disability and the composite outcome (P for interaction < 0.05 for both). A significant linear trend existed between 25-hydroxyvitamin D and risk of poor prognosis (P = 0.03). CONCLUSIONS:Vitamin D deficiency may be merely an independent risk factor of poor prognosis in ischaemic strokepatients with low HDLC level.