51
|
Lepsch J, Eshriqui I, Farias DR, Vaz JS, Cunha Figueiredo AC, Adegboye ARA, Brito A, Mokhtar R, Allen LH, Holick MF, Kac G. Association between early pregnancy vitamin D status and changes in serum lipid profiles throughout pregnancy. Metabolism 2017; 70:85-97. [PMID: 28403948 DOI: 10.1016/j.metabol.2017.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the associations between first trimester 25-hydroxyvitamin D [25(OH)D] status and changes in high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), triglyceride (TG) concentrations, TG/HDL-c, and TC/HDL-c ratios throughout pregnancy. We hypothesized that first trimester 25(OH)D inadequacy is associated with lower concentrations of HDL-c and higher LDL-c, TC, TG, TG/HDL-c, and TC/HDL-c ratios throughout pregnancy. METHODS A prospective cohort study with 3 visits at 5-13 (baseline), 20-26, and 30-36 gestational weeks, recruited 194 pregnant women attending a public health care center in Rio de Janeiro, Brazil. Plasma 25(OH)D concentrations were measured in the first trimester using liquid chromatography-tandem mass spectrometry. 25(OH)D concentrations were classified as adequate (≥75nmol/L) or inadequate (<75nmol/L). Serum TC, HDL-c, and TG concentrations were measured enzymatically. Crude and adjusted longitudinal linear mixed-effects models were employed to evaluate the association between the first trimester 25(OH)D status and changes in serum lipid concentrations throughout pregnancy. Confounders adjusted for in the multiple analysis were age, homeostatic model assessment (HOMA), early pregnancy BMI, leisure time physical activity before pregnancy, energy intake, and gestational age. RESULTS At baseline, 69% of the women had inadequate concentrations of 25(OH)D. Women with 25(OH)D inadequacy had higher mean LDL-c than those with adequate concentrations (91.3 vs. 97.5mg/dL; P=0.064) at baseline. TC, HDL-c, LDL-c TG, TG/HDL-c ratios, and TC/HDL-c ratios, increased throughout pregnancy independently of 25(OH)D concentrations (ANOVA for repeated measures P<0.001). The adjusted models showed direct associations between the first trimester 25(OH)D status and changes in TC (β=9.53; 95%CI=1.12-17.94), LDL-c (β=9.99; 95% CI=3.62-16.36) concentrations, and TC/HDL-c ratios (β=0.16; 95% CI=0.01-0.31) throughout pregnancy. CONCLUSIONS Inadequate plasma 25(OH)D concentrations during early pregnancy were associated with more pronounced changes of TC, LDL-c concentrations, and TC/HDL-c ratios throughout pregnancy. Changes in these cardiovascular markers suggest the importance of ensuring adequate vitamin D status at the beginning of pregnancy.
Collapse
Affiliation(s)
- Jaqueline Lepsch
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
| | - Ilana Eshriqui
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
| | - Juliana S Vaz
- Faculty of Nutrition, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Amanda C Cunha Figueiredo
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
| | | | - Alex Brito
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, USA
| | | | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, USA
| | | | - Gilberto Kac
- Rio de Janeiro Federal University, Josué de Castro Nutrition Institute, Department of Social and Applied Nutrition, Avenida Carlos Chagas Filho, 373 - CCS - Bloco J, Suite 29, Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ, 21941-590, Brazil.
| |
Collapse
|
52
|
Alfieri DF, Lehmann MF, Oliveira SR, Flauzino T, Delongui F, de Araújo MCM, Dichi I, Delfino VD, Mezzaroba L, Simão ANC, Reiche EMV. Vitamin D deficiency is associated with acute ischemic stroke, C-reactive protein, and short-term outcome. Metab Brain Dis 2017; 32:493-502. [PMID: 27975188 DOI: 10.1007/s11011-016-9939-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 12/07/2016] [Indexed: 12/11/2022]
Abstract
The aim of this study was to investigate whether vitamin D deficiency (VDD) is associated with acute ischemic stroke, inflammatory markers, and short-term outcome. 168 acute ischemic stroke patients and 118 controls were included. The modified Rankin Scale (mRS) was applied up to 8 h of admission (baseline) and after three-months follow-up, and blood samples were obtained up to 24 h of admission to evaluate serum levels of 25-hydroxivitamin D [25(OH)D] and inflammatory markers. Vitamin D levels classified the individuals in sufficient (VDS ≥ 30.0 ng/mL), insufficient (VDI 20.0-29.9 ng/mL), and deficient (VDD < 20.0 ng/mL) status. Patients had lower levels of 25(OH)D, higher frequency of VDD (43.45% vs. 5.08%, OR: 16.64, 95% CI: 5.66-42.92, p < 0.001), and higher inflammatory markers than controls (p < 0.05). Patients with VDD showed increased high sensitivity C-reactive protein (hsCRP) levels than those with VDS status (p = 0.043); those with poor outcome presented with lower 25(OH)D levels than those with good outcome (p = 0.008); moreover, 25(OH)D levels were negatively correlated with mRS after three-months follow-up (r = -0.239, p = 0.005). The associations between VDD and higher hsCRP levels and between 25(OH)D levels and poor outcome at short-term in acute ischemic stroke patients suggest the important role of vitamin D in the inflammatory response and pathophysiology of this ischemic event.
Collapse
Affiliation(s)
- Daniela Frizon Alfieri
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Márcio Francisco Lehmann
- Department of Clinical Surgery, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Sayonara Rangel Oliveira
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Tamires Flauzino
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Francieli Delongui
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | | | - Isaias Dichi
- Departmet of Clinical Medicine, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Vinícius Daher Delfino
- Departmet of Clinical Medicine, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Leda Mezzaroba
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, CEP 86.038-440, Londrina, Paraná, Brazil
| | - Andréa Name Colado Simão
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, CEP 86.038-440, Londrina, Paraná, Brazil
| | - Edna Maria Vissoci Reiche
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, CEP 86.038-440, Londrina, Paraná, Brazil.
| |
Collapse
|
53
|
Zhang R, Li B, Gao X, Tian R, Pan Y, Jiang Y, Gu H, Wang Y, Wang Y, Liu G. Serum 25-hydroxyvitamin D and the risk of cardiovascular disease: dose-response meta-analysis of prospective studies. Am J Clin Nutr 2017; 105:810-819. [PMID: 28251933 DOI: 10.3945/ajcn.116.140392] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
Background: During the past decade, an increasing number of prospective studies have focused on the association between vitamin D and cardiovascular disease (CVD). However, the evidence on the relation between serum 25-hydroxyvitamin D [25(OH)D] and the risk of overt CVD is inconclusive.Objective: We performed a dose-response meta-analysis to summarize and prospectively quantify the RR of low serum 25(OH)D concentration and total CVD (events and mortality).Design: We identified relevant studies by searching PubMed and EMBASE up to December 2015 and by hand-searching reference lists. Prospective studies based on the general population and reported RRs and 95% CIs were included. A random-effects model was used to calculate the pooled RRs. Nonlinear association was assessed by using restricted cubic spline analyses.Results: A total of 34 publications with 180,667 participants were eligible for the meta-analysis. We included 32 publications (27 independent studies) for total CVD events and 17 publications (17 independent studies) for CVD mortality. We observed an inverse association between serum 25(OH)D and total CVD events and CVD mortality, and the pooled RRs per 10-ng/mL increment were 0.90 (95% CI: 0.86, 0.94) for total CVD events and 0.88 (95% CI: 0.80, 0.96) for CVD mortality. A nonlinear association was detected for total CVD events (P-nonlinear < 0.001) and CVD mortality (P-nonlinear = 0.022).Conclusion: Serum 25(OH)D concentration was inversely associated with total CVD events and CVD mortality from the observed studies.
Collapse
Affiliation(s)
- Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Bohong Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, State College, PA
| | - Rui Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Hongqiu Gu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; .,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; and
| |
Collapse
|
54
|
Kamal AK, Majeed F, Naqvi I. Vitamin D supplementation for preventing recurrent stroke and vascular events in patients with stroke or transient ischaemic attack. Hippokratia 2017. [DOI: 10.1002/14651858.cd009762.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ayeesha K Kamal
- Aga Khan University Hospital; Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine; Stadium Road PO Box 3500 Karachi Pakistan 74800
| | - Farzin Majeed
- Aga Khan University Hospital; Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine; Stadium Road PO Box 3500 Karachi Pakistan 74800
| | - Imama Naqvi
- Aga Khan University Hospital; Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine; Stadium Road PO Box 3500 Karachi Pakistan 74800
| |
Collapse
|
55
|
Narasimhan S, Balasubramanian P. Role of Vitamin D in the Outcome of Ischemic Stroke- A Randomized Controlled Trial. J Clin Diagn Res 2017; 11:CC06-CC10. [PMID: 28384856 DOI: 10.7860/jcdr/2017/24299.9346] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/28/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Vitamin D deficiency has reached epidemic proportions in India with prevalence rates of 70-100% in the general population. Low vitamin D levels are associated with worse outcomes in ischemic strokes. The outcome of stroke after vitamin D replenishment has not been much studied. AIM To compare the stroke outcome between patients receiving vitamin D supplementation and patients without vitamin D supplementation by Scandinavian Stroke Scale (SSS) and thus, to assess the long term outcome of ischemic stroke patients with low vitamin D level by supplementation of vitamin D. MATERIALS AND METHODS This is a non blinded randomized controlled trial conducted in ischemic stroke patients. The patients were divided into two groups (A and B) where Group A received a single dose of 6 lac IU of Cholecalciferol Intramascular (IM) injection and Group B were not given vitamin D. Finally 30 patients in each group were analyzed. SSS was applied to evaluate the stroke severity at the onset and at the follow up after three months in both groups. The difference in SSS was analyzed using SPSS software. Independent t-test was applied and p-value < 0.05 was taken as significant. RESULTS Mean±SD of vitamin D levels in Group A and Group B were 17.98±3.81ng/ml and 18.44±4.69 ng/ml respectively. Mean±SD of SSS at time of admission and after three months for Group A was 32.50±11.61 and 38.89±8.34; and for Group B 35.82±8.56 and 38.32±7.10. The difference in SSS from time of admission and after three months, in Group A (6.39±4.56) and Group B (2.50±2.20) were analyzed statistically and found to be highly significant (p<0.001). CONCLUSION The results showed that there is a significant improvement in the stroke outcome after three months in those patients who were supplemented with vitamin D. Thus screening for vitamin D deficiency in stroke patients is essential and vitamin D replenishment will improve the stroke outcome.
Collapse
Affiliation(s)
- Shuba Narasimhan
- Associate Professor, Department of Physiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | | |
Collapse
|
56
|
Relationship between serum 25-hydroxyvitamin D levels and the SYNTAX score in patients with acute coronary syndrome. Anatol J Cardiol 2017; 17:293-297. [PMID: 28179617 PMCID: PMC5469109 DOI: 10.14744/anatoljcardiol.2016.6977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The extent of severity and complexity of coronary artery disease (CAD) in patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) and possible correlations between serum 25-hydroxyvitamin D (25(OH)D) have not yet been adequately studied. We evaluated the relationship between 25(OH)D levels and the burden of CAD as assessed by the SYNTAX score (SXscore) in patients with acute coronary syndrome (ACS) including STEMI and NSTEMI. METHODS After exclusion, a total of 113 patients who were admitted to our hospital due to ACS and who were referred for undergoing coronary angiography were prospectively included. Their mean age was 63.3±18.5 years, and 80.5% of them were men. In total, 44.2% of the patients had NSTEMI and the remaining had STEMI. Blood samples were drawn at admission to evaluate serum 25(OH)D levels. CAD severity was assessed using the SXscore. Patients were classified as having low (SXscore ≤22) or high (SXscore >22) SXscores. Pearson's and Spearman's correlation coefficients were used to examine the relationship between serum 25(OH)D levels and the SXscore. RESULTS 25(OH)D levels were significantly lower in the group with a high SXscore than in the group with a low SXscore (21.0±8.0 vs. 16.7±6.8, p=0.005). Correlation analysis showed a significant correlation between 25(OH)D levels and the SXscore. Multiple linear regression (MLR) analysis was used to determine the significance of the relationship between the SXscore and 25(OH)D, parathyroid hormone, and C-reactive protein levels and eGFR. MLR analysis revealed that only 25(OH)D levels (coefficient beta, -0.217, p=0.029) was significantly associated with the severity of CAD. CONCLUSION The present study showed that serum 25(OH)D levels were significantly lower in patients with STEMI/NSTEMI and that low serum 25(OH)D levels were significantly correlated with CAD severity and extent.
Collapse
|
57
|
Parathyroid Hormone Levels in the Prediction of Ischemic Stroke Risk. DISEASE MARKERS 2017; 2017:4343171. [PMID: 28115793 PMCID: PMC5237770 DOI: 10.1155/2017/4343171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022]
Abstract
Objective. It was examined whether PTH and 25-dihydroxyvitamin D (25(OH)D) levels, together or separately, are indicators of the risk of stroke. Materials and Methods. This prospective study was performed at two centers. In the study, 100 patients diagnosed with acute ischemic stroke and 100 control individuals in the same age range were examined. In addition to neurological examination, cranial imaging, extensive routine blood chemistry, PTH, and 25(OH)D levels were evaluated in all cases. Stroke risk factors were determined. Logistic regression was used for statistical analysis. Results. A total of 60 patients and 79 control individuals were included in the study. Different estimation models were designed in order to examine the relationship between PTH and 25(OH)D levels with stroke. According to modeling results, it was determined that the most effective predictor for risk of stroke was 25(OH)D levels, followed by hypertension and PTH levels, respectively. Conclusion. PTH and 25(OH)D levels together can make important contributions to determination of stroke risk, and further investigations are needed to understand this relationship more fully.
Collapse
|
58
|
Souza WN, Aparicio-Ugarriza R, Bibiloni MM, Palacios G, Aguilar I, Tur JA, González-Gross M. Better Body Composition and Lipid Profile Can Be Associated with Vitamin D Status in Spanish Elderly? The PHYSMED Study. J Nutr Health Aging 2017; 21:1329-1336. [PMID: 29188897 DOI: 10.1007/s12603-017-0949-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies have shown that vitamin D deficiency increases the risk for lipid metabolism disorders, but this relationship has provided inconsistent results in elderly. Thus the aim was to assess the association between body composition and blood lipid profile levels on serum 25-hydrovitamin D [25(OH)D] concentration in Spanish elderly. A cross-sectional multicentre study was carried out in 383 participants (58.2% females) aged of 55-88 years. Fasting blood samples analyzed serum concentrations of 25(OH)D, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG) and total cholesterol (TC). Body composition parameters (fat mass, fat free mass) were obtained by bioimpedance, waist circumference (WC), physical activity and vitamin D intake were also evaluated. BMI, fat mass and total fat mass were lower in vitamin D sufficient subjects than vitamin D insufficient and deficient subjects, but this difference was not significant (p>0,05). Those with vitamin D adequate levels also showed lower TC/HDL ratio than those who had inadequate (insufficient or deficient) vitamin D levels (p=0.04). Significant association between 25(OH)D and BMI, waist circumference, total muscle mass, TC/HDL-c ratio, HDL and TG (for all p≤ 0.05) was found after controlling for some confounders. Subjects with inadequate HDL levels (<40mg/dL) showed 1.7 times higher odds than vitamin D deficiency than those with adequate HDL levels (>60mg/dL) (95% CI= 1.10 to 2.85 p= 0.017) and WC was negatively associated with vitamin D status odds ratio of 0.98 (0.96 to 1.00; p= 0.04). Vitamin D concentration was positively correlated with HDL-c and total muscle mass, as well as negatively correlated with WC, LDL-c/HDL-c and TC/HDL-c independently of age, gender and some confounders.
Collapse
Affiliation(s)
- W N Souza
- Dr. Marcela González Gross, ImFINE Research Group. Department of Health and Human Performance. Faculty of Physical Activity and Sport Sciences (INEF). Universidad Politécnica de Madrid (Spain) e-mail:
| | | | | | | | | | | | | |
Collapse
|
59
|
Judd SE, Morgan CJ, Panwar B, Howard VJ, Wadley VG, Jenny NS, Kissela BM, Gutiérrez OM. Vitamin D deficiency and incident stroke risk in community-living black and white adults. Int J Stroke 2016; 11:93-102. [PMID: 26763025 DOI: 10.1177/1747493015607515] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Black individuals are at greater risk of stroke and vitamin D deficiency than white individuals. Epidemiologic studies have shown that low 25-hydroxyvitamin D concentrations are associated with increased risk of stroke, but these studies had limited representation of black individuals. METHODS We examined the association of 25-hydroxyvitamin D with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults ≥45 years of age. Using a case-cohort study design, plasma 25-hydroxyvitamin D was measured in 610 participants who developed incident stroke (cases) and in 937 stroke-free individuals from a stratified cohort random sample of REGARDS participants (comparison cohort). RESULTS In multivariable models adjusted for socio-demographic factors, co-morbidities and laboratory values including parathyroid hormone, lower 25-hydroxyvitamin D concentrations were associated with higher risk of stroke (25-hydroxyvitamin D >30 ng/mL reference; 25-hydroxyvitamin D concentrations 20-30 ng/mL, hazard ratio 1.33, 95% confidence interval (95% CI) 0.89,1.96; 25-hydroxyvitamin D <20 ng/mL, hazard ratio 1.85, 95% CI 1.17, 2.93). There were no statistically significant differences in the association of lower 25-hydroxyvitamin D with higher risk of stroke in black vs. white participants in fully adjusted models (hazard ratio comparing lowest vs. highest 25-hydroxyvitamin D category 2.62, 95% CI 1.18, 5.83 in blacks vs. 1.64, 95% CI 0.83, 3.24 in whites, P(interaction) = 0.82). The associations were qualitatively unchanged when restricted to ischemic or hemorrhagic stroke subtypes or when using race-specific cut-offs for 25-hydroxyvitamin D categories. CONCLUSIONS Vitamin D deficiency is a risk factor for incident stroke and the strength of this association does not appear to differ by race.
Collapse
Affiliation(s)
- Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Charity J Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Bhupesh Panwar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Virginia G Wadley
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Nancy S Jenny
- Departments of Medicine and Pathology, University of Vermont, Burlington, USA
| | - Brett M Kissela
- Department of Neurology, University of Cincinnati, Cincinnati, USA
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| |
Collapse
|
60
|
Huang H, Zheng T, Wang S, Wei L, Wang Q, Sun Z. Serum 25-hydroxyvitamin D predicts early recurrent stroke in ischemic stroke patients. Nutr Metab Cardiovasc Dis 2016; 26:908-914. [PMID: 27461862 DOI: 10.1016/j.numecd.2016.06.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM This study was conducted to determine 25-hydroxyvitamin D [25(OH) D] levels in serum, and to investigate their associations with stroke recurrence events in a 3-month follow-up study in Chinese patients with first-ever ischemic stroke. METHODS AND RESULTS From February 2014 to September 2015, consecutive first-ever ischemic stroke patients admitted to the Department of Emergency of our hospital were identified. Serum 25(OH) D levels were measured at admission. We followed the participants for a median of 3 months (range, 2.5-3.5 months) using a standard questionnaire. We used logistic regression models to assess the relationship between 25(OH) levels and risk of recurrent stroke. In this study, 349 ischemic stroke patients were included and completed follow-up. Thirty-seven patients (10.6%) had a stroke recurrence. Serum 25(OH) D levels in patients with recurrent stroke were significantly lower as compared with those in patients without recurrent stroke [9.9 (IQR, 7.9-14.8) ng/mL vs. 17.9 (IQR, 13.4-23.4) ng/mL; P < 0.001). After adjusting for traditional risk factors, serum 25(OH) D levels were negatively associated with the stroke recurrence (OR, 0.897; 95% CI, 0.848-0.950; P < 0.001). Compared with the first quartile of serum 25(OH) D levels, the second quartile OR for recurrent stroke was 0.466 (95% CI, 0.308-707; P = 0.006). For the third and fourth quartiles, it was 0.248 (95% CI, 0.100-0.618; P = 0.001) and 0.173 (95% CI, 0.062-0.482; P < 0.001), respectively. CONCLUSIONS Our findings suggest that reduced serum levels of 25(OH) D can predict the risk of early stroke recurrence in patients with first-ever ischemic stroke.
Collapse
Affiliation(s)
- H Huang
- Department of Neurology, The Branch of First People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - T Zheng
- Department of Neurology, The Branch of First People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - S Wang
- Department of Neurology, The Branch of First People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - L Wei
- Department of Neurosurgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Q Wang
- Department of Neurosurgery, East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Z Sun
- Department of Neurosurgery, East Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
61
|
Gupta A, Prabhakar S, Modi M, Bhadada SK, Kalaivani M, Lal V, Khurana D. Effect of Vitamin D and calcium supplementation on ischaemic stroke outcome: a randomised controlled open-label trial. Int J Clin Pract 2016; 70:764-70. [PMID: 27561415 DOI: 10.1111/ijcp.12866] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/06/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND AIMS Vitamin D deficiency is a common problem in stroke survivors. Observational studies have reported an association of low vitamin D levels with greater stroke severity, poststroke mortality and functional disability. Randomised clinical trials are lacking. We sought to assess the effect of calcium and vitamin D supplementation in ischaemic stroke survivors with vitamin D deficiency/insufficiency on disability/mortality outcomes. METHODS In this randomised controlled open-label trial, 73 patients of acute ischaemic stroke were screened for serum 25 hydroxy Vitamin D (25(OH)D) levels. A total of 53 patients with baseline 25(OH)D <75 nmol/L were randomised into two arms. One received vitamin D and calcium supplementation along with usual care (n=25) and the other received usual care alone (n=28). Primary outcome was the proportion of patients achieving a good outcome [modified Rankin Scale score 0-2] at 6 months and all cause mortality at 6 months. RESULTS The age (mean±SD) of participants was 60.4±11.3 years, 69.8% were males. The proportion of patients achieving good outcome was higher in the intervention arm (Adjusted OR 1.9, 95% CI 0.6-6.4; P=.31). The survival probability was greater in the intervention arm (83.8%, CI 62.4-93.6) as compared with the control arm (59.5%, CI 38.8-75.2; P=.049) with adjusted Hazard ratio (HR) of 0.26 (95% CI 0.08-0.9; P=.03). CONCLUSIONS This is the first randomised controlled study assessing the effect of vitamin D and calcium supplementation on ischaemic stroke outcomes and points towards a potential benefit. Findings need to be validated by a larger trial.
Collapse
Affiliation(s)
- Anu Gupta
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudesh Prabhakar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay K Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
62
|
Abstract
Background: Vitamin D plays an important role in several systems of the human body. Various studies have linked vitamin D deficiency to stress and insufficiency fractures, muscle recovery and function, and athletic performance. The prevalence of vitamin D deficiency in the elite athletic population has not been extensively studied, and very few reports exist among professional athletes. Hypothesis: There is a high prevalence of vitamin D deficiency or insufficiency among players attending the National Basketball Association (NBA) Combine. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This is a retrospective review of data previously collected as part of the routine medical evaluation of players in the NBA Combines from 2009 through 2013. Player parameters evaluated were height, weight, body mass index (BMI), and vitamin D level. Statistical analysis using t tests and analysis of variance was used to detect any correlation between the player parameters and vitamin D level. Vitamin D levels were categorized as deficient (<20 ng/mL), insufficient (20-32 ng/mL), and sufficient (>32 ng/mL). Results: After institutional review board approval was submitted to the NBA, the NBA released deidentified data on 279 players who participated in the combines from 2009 through 2013. There were 90 players (32.3%) who were deficient, 131 players (47.0%) who were insufficient, and 58 players (20.8%) who were sufficient. A total of 221 players (79.3%) were either vitamin D deficient or insufficient. Among all players included, the average vitamin D level was 25.6 ± 10.2 ng/mL. Among the players who were deficient, insufficient, and sufficient, the average vitamin D levels were 16.1 ± 2.1 ng/mL, 25.0 ± 3.4 ng/mL, and 41.6 ± 8.6 ng/mL, respectively. Player height and weight were significantly increased in vitamin D–sufficient players compared with players who were not sufficient (P = .0008 and .009, respectively). Player age and BMI did not significantly differ depending on vitamin D status (P = .15 and .77, respectively). Conclusion: There is a high prevalence of vitamin D deficiency or insufficiency among participants in the NBA Combines. As a result, there should be a high suspicion for this metabolic abnormality among elite basketball players. Clinical Relevance: Vitamin D level has been linked to bone health, muscle recovery and function, and athletic performance. Because of the high prevalence of vitamin D deficiency in the NBA Combines, clinicians should maintain a high suspicion for vitamin D abnormalities among elite basketball players.
Collapse
|
63
|
Savanelli MC, Scarano E, Muscogiuri G, Barrea L, Vuolo L, Rubino M, Savastano S, Colao A, Di Somma C. Cardiovascular risk in adult hypopituitaric patients with growth hormone deficiency: is there a role for vitamin D? Endocrine 2016; 52:111-9. [PMID: 26511949 DOI: 10.1007/s12020-015-0779-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/16/2015] [Indexed: 11/26/2022]
Abstract
Hypovitaminosis D represent an environmental risk factors for cardiovascular (CV) disease. To investigate the prevalence of hypovitaminosis D and the correlation between GH/IGF-I deficiency and hypovitaminosis D with CV risk in GH deficiency (GHD) patients. A link between these hormones has been shown. Forty-one hypopituitaric patients with GHD (22 males, age 18-84 years) and 41 controls were enrolled in the study. Anthropometric parameters, blood pressure, glucose and lipid profile, parathyroid hormone (PTH), 25(OH) vitamin D (vitamin D), metabolic syndrome (MS), GH peak after GHRH + ARG, IGF-I, and standard deviation score (SDS) of IGF-I (zIGF-I) were assessed. Vitamin D levels were lower in patients than in controls (21.3 ± 12.3 vs. 28.2 ± 9.4, p = 0.006). Deficiency was found in 51 % of patients versus 14.6 % of controls (p < 0.01), insufficiency in 26.8 versus 41.4 % (p = 0.269) and normal vitamin D levels in 21.9 versus 43.9 % (p = 0.060). The prevalence of dyslipidemia was 51.2 % in patients versus 12.1 % in controls (p < 0.001), type 2 diabetes mellitus (DM) was 7.3 versus 17 % (p = 0.292), hypertension was 44 versus 22 % (p = 0.060), and MS was 17 versus 14.6 % (p = 0.957). In patients, an association was found between the presence of hypovitaminosis D and the prevalence of dyslipidemia, hypertension and MS and between zIGF-I and the prevalence of hypertension. Hypovitaminosis D was the most powerful predictor of the prevalence of dyslipidemia and hypertension. GHD patients have an increased prevalence of hypovitaminosis D compared with controls. The presence of hypovitaminosis D was the most powerful predictor of the prevalence of dyslipidemia and hypertension in GHD patients, suggesting the involvement of both factors in the CV risk in these patients.
Collapse
Affiliation(s)
| | - Elisabetta Scarano
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | | | - Laura Vuolo
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | - Manila Rubino
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Section of Endocrinology, University "Federico II", Naples, Italy
| | | |
Collapse
|
64
|
Abstract
Vitamin D deficiency is a worldwide public health problem. Vitamin D deficiency plays key role in the pathophysiology of risk factors of metabolic syndrome which affect cardiovascular system, increase insulin resistance and obesity, stimulate rennin-angiotensin-aldosterone system that cause hypertension. The discovery of vitamin D receptor expressed ubiquitously in almost all body cells such as immune, vascular and myocardial cells, pancreatic beta cells, neurons and osteoblasts suggests an involvement of vitamin D mediated effects on metabolic syndrome. Moreover vitamin D deficiency as well as cardiovascular diseases and related risk factors frequently co-occur. This underlines the importance of understanding the role of vitamin D in the context of metabolic syndrome. The paper provides an insight into the physiology of vitamin D and relationship of vitamin D deficiency with risk factors of metabolic syndrome through observational and supplementation studies.
Collapse
Affiliation(s)
- Priyanka Prasad
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana 141004, Punjab, India.
| | - Anita Kochhar
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana 141004, Punjab, India.
| |
Collapse
|
65
|
Snoddy AME, Buckley HR, Halcrow SE. More than metabolic: Considering the broader paleoepidemiological impact of vitamin D deficiency in bioarchaeology. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 160:183-96. [PMID: 26926781 DOI: 10.1002/ajpa.22968] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 12/20/2022]
Abstract
Vitamin D deficiency has traditionally been viewed as a metabolic bone disease by bioarchaeologists and considered primarily in terms of the development of specific musculoskeletal changes used for diagnosis in paleopathological research. These skeletal manifestations are usually interpreted as representing general ill-health. Clinical research shows that vitamin D is also integral to a number of extra-skeletal physiological processes including immunoregulation, blood pressure homeostasis, cell division, and programmed cell death. Vitamin D deficiency and sub-clinical insufficiency are thought to be risk factors for infectious and autoimmune diseases, as well as certain cancers and cardiovascular diseases. Epidemiological work indicates that the skeletal manifestations of vitamin D deficiency represent the extreme end of a spectrum of morbidity associated with negative health outcomes, including increased risk for secondary tuberculosis. This article provides a review of clinical research on the extra-skeletal roles of vitamin D and the pathological consequences of poor vitamin D status. Additionally, it presents an interpretive model for bioarchaeological analyses of rickets and osteomalacia for consideration of the whole-body impact of poor vitamin D nutriture and possible comorbidities that may have affected the wider population. Am J Phys Anthropol 160:183-196, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Anne Marie E Snoddy
- Department of Anatomy, University of Otago, Dunedin, Otago, 9016, New Zealand
| | - Hallie R Buckley
- Department of Anatomy, University of Otago, Dunedin, Otago, 9016, New Zealand
| | - Siân E Halcrow
- Department of Anatomy, University of Otago, Dunedin, Otago, 9016, New Zealand
| |
Collapse
|
66
|
Muscogiuri G, Nuzzo V, Gatti A, Zuccoli A, Savastano S, Di Somma C, Pivonello R, Orio F, Colao A. Hypovitaminosis D: a novel risk factor for coronary heart disease in type 2 diabetes? Endocrine 2016; 51:268-73. [PMID: 25931413 DOI: 10.1007/s12020-015-0609-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
Abstract
Vitamin D (25(OH)D) levels have been associated with cardiovascular disease. Thus, the aim of our study was to investigate the association of 25(OH)D levels with coronary heart disease (CHD) in 698 consecutive type 2 diabetic outpatients. 698 consecutive type 2 diabetic outpatients (25.2 % men, age 66 ± 9 years) and 100 (90 % men, age 65 ± 13 years) age-matched non-diabetic volunteers were enrolled. 25(OH)D assay and the main cardiovascular risk factors were explored. 25(OH)D concentration was 22 ± 10 ng/ml in control subjects and 18.23 ± 10 ng/ml in diabetic patients (p < 0.01). The prevalence of hypovitaminosis D was higher in diabetic patients than in control subjects (90 vs. 83 %, p < 0.01). Diabetic subjects with hypovitaminosis D had higher prevalence of high values of A1C (p < 0.01), BMI (p < 0.01), LDL cholesterol (p < 0.01), triglycerides (p < 0.01), and glycemia (p < 0.01) than their vitamin D-sufficient counterparts. 25(OH)D and HDL cholesterol were lower (p < 0.01), while BMI (p < 0.01), age (p < 0.01), systolic (p < 0.01) and diastolic blood pressure (p < 0.01), diabetes duration (p < 0.01), A1C (p < 0.01), glycemia (p < 0.01), fibrinogen (p < 0.01), triglycerides (p < 0.01), and total (p < 0.01) and LDL cholesterol (p < 0.01) were higher in diabetic subjects with CHD than diabetic subjects without CHD. At the logistic regression analysis, the association of vitamin D with CHD was lost, while sex (p = 0.026), diabetes duration (p = 0.023), and age (p = 0.024) were the most powerful predictors of CHD. The current study demonstrates that 25(OH)D does not have a direct effect on CHD but may have an indirect effect mediated by cardiovascular risk factors such as diabetes duration, age, and sex.
Collapse
Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", via S. Pansini 5, 80131, Naples, Italy.
| | - Vincenzo Nuzzo
- Internal Medicine Unit, San Gennaro Hospital, Naples, Italy
| | - Adriano Gatti
- Diabetology Unit, San Gennaro Hospital, Naples, Italy
| | | | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", via S. Pansini 5, 80131, Naples, Italy
| | | | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", via S. Pansini 5, 80131, Naples, Italy
| | - Francesco Orio
- Department of Endocrinology, University "Parthenope" Naples, Naples, Italy
- Endocrinology of Fertile Age, "S. Giovanni di Dio e Ruggi d'Aragona" University Hospital Salerno, Salerno, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", via S. Pansini 5, 80131, Naples, Italy
| |
Collapse
|
67
|
Martinez‐Moreno JM, Herencia C, Oca AMD, Muñoz‐Castañeda JR, Rodríguez‐Ortiz ME, Díaz‐Tocados JM, Peralbo‐Santaella E, Camargo A, Canalejo A, Rodriguez M, Velasco‐Gimena F, Almaden Y. Vitamin D modulates tissue factor and protease‐activated receptor 2 expression in vascular smooth muscle cells. FASEB J 2015; 30:1367-76. [DOI: 10.1096/fj.15-272872] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 11/16/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Julio M. Martinez‐Moreno
- Metabolism and Vascular Calcification UnitReina Sofia University HospitalUniversity of CordobaCordobaSpain
| | - Carmen Herencia
- Metabolism and Vascular Calcification UnitReina Sofia University HospitalUniversity of CordobaCordobaSpain
| | - Addy Montes de Oca
- Metabolism and Vascular Calcification UnitReina Sofia University HospitalUniversity of CordobaCordobaSpain
| | | | | | - Juan M. Díaz‐Tocados
- Metabolism and Vascular Calcification UnitReina Sofia University HospitalUniversity of CordobaCordobaSpain
| | - Esther Peralbo‐Santaella
- Microscopy, Cytomics, and Scientific Imaging UnitReina Sofia University HospitalUniversity of CordobaCordobaSpain
| | - Antonio Camargo
- Lipid and Atherosclerosis UnitReina Sofia University HospitalUniversity of CordobaCordobaSpain
- Centros de Investigación Biomédica en Red (CIBER) Fisiopatologia Obesidad y Nutricion (CIBEROBN)Instituto de Salud Carlos IIICordobaSpain
| | - Antonio Canalejo
- Department of Environmental Biology and Public HealthUniversity of HuelvaHuelvaSpain
| | - Mariano Rodriguez
- Nephrology ServiceReina Sofia University HospitalUniversity of CordobaCordobaSpain
| | - Francisco Velasco‐Gimena
- Hematology ServiceInstituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)Reina Sofia University HospitalUniversity of CordobaCordobaSpain
| | - Yolanda Almaden
- Lipid and Atherosclerosis UnitReina Sofia University HospitalUniversity of CordobaCordobaSpain
- Centros de Investigación Biomédica en Red (CIBER) Fisiopatologia Obesidad y Nutricion (CIBEROBN)Instituto de Salud Carlos IIICordobaSpain
| |
Collapse
|
68
|
Abdel Rahman MA, Galal H, Omar AMS. Correlation between serum vitamin D level and cardiac function: Echocardiographic assessment. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2015.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
69
|
Kiggundu DS, Mutebi E, Kibirige D, Boxer R, Kakande B, Kigozi BK, Katabira E. Vitamin D deficiency and its characteristics among patients with acute stroke at a national referral hospital in Kampala Uganda. BMC Endocr Disord 2015; 15:53. [PMID: 26437924 PMCID: PMC4594645 DOI: 10.1186/s12902-015-0053-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/01/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Vitamin D deficiency has been associated with acute stroke and other cardiovascular diseases in the developed world. Low 25-hydroxyvitamin D (25OHD) has been described in some populations in Sub-Saharan Africa (SSA) in spite of adequate sunshine all year round. There is no information on the magnitude of vitamin D deficiency among patients with stroke and other cardiovascular diseases in Uganda or SSA. The aim of this study was to determine the burden and characteristics of vitamin D deficiency among patients with acute stroke, the most common form of cardiovascular events in SSA. METHODS We conducted a cross-sectional study between October 2012 and March 2013. We consecutively recruited 142 subjects with acute stroke admitted to the medical wards of Mulago hospital. We administered a pre-tested questionnaire to the study participants, and did a detailed physical examination and laboratory evaluation. Serum levels of 25OHD were determined using an electrochemiluminescence assay. Data were analyzed using STATA version 12 software. RESULTS The prevalence of vitamin D deficiency (25OHD < 20 ng/ml) was 15 %. Longer hours of sunshine exposure decreased the likelihood vitamin D deficiency significantly (adjusted OR 0.85, p = 0.03). Higher HDL cholesterol had a significant inverse association with vitamin D deficiency (adjusted OR 0.15, p = 0.02). In addition, the likelihood of vitamin D deficiency increased with rising age (adjusted OR 1.03, p = 0.05). CONCLUSIONS There was a relatively low burden of vitamin D deficiency among patients with acute stroke in Uganda. With increasing longevity and indoor lifestyles vitamin D deficiency may assume a greater role in stroke and other cardiovascular diseases in tropical sub Saharan Africa. Future studies on the mechanisms of vitamin D deficiency and its relationship to outcomes among patients with stroke may be necessary.
Collapse
Affiliation(s)
- Daniel S Kiggundu
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Edrisa Mutebi
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital, Lubaga, Kampala, Uganda.
| | - Rebecca Boxer
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | | | | | - Elly Katabira
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| |
Collapse
|
70
|
Turetsky A, Goddeau RP, Henninger N. Low Serum Vitamin D Is Independently Associated with Larger Lesion Volumes after Ischemic Stroke. J Stroke Cerebrovasc Dis 2015; 24:1555-63. [PMID: 26009498 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.051] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/13/2015] [Accepted: 03/15/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite its high prevalence, known association with vascular disease and stroke incidence and fatality, little is known about the contribution of vitamin D status to a worse outcome after ischemic stroke. Therefore, we sought to assess whether low serum 25-hydroxyvitamin D (25[OH]D), a marker of vitamin D status, is predictive of the ischemic infarct volume and whether it relates to a worse outcome. METHODS We retrospectively analyzed prospective, consecutive acute ischemic stroke patients evaluated from January 2013 to January 2014 at a tertiary referral center. All patients (n = 96) had a magnetic resonance imaging-proven acute ischemic stroke. Multivariable linear and logistic regression analyses were used to test whether vitamin D represents an independent predictor of infarct volume and poor 90-day outcome (modified Rankin Scale score of >2). RESULTS In univariable analyses, lacunar infarct etiology, lower admission National Institutes of Health Stroke Scale, and higher serum 25(OH)D concentration were associated with smaller infarct volumes (P < .05). The association of 25(OH)D with ischemic infarct volume was independent of other known predictors of the infarct extent (P = .001). Multivariable analyses showed that the risk for a poor 90-day outcome doubled with each 10-ng/mL decrease in serum 25(OH)D. CONCLUSIONS Low serum 25(OH)D was independently associated with larger ischemic infarct volume, which may partially explain observed worse outcomes in ischemic stroke patients with poor vitamin D status. Although causality remains to be proven, our results provide the rationale to further explore vitamin D as a promising marker for cerebral ischemic vulnerability and to identify stroke patients at high risk for poor outcome.
Collapse
Affiliation(s)
- Anya Turetsky
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Richard P Goddeau
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.
| |
Collapse
|
71
|
Is vitamin D deficiency related to accumulation of advanced glycation end products, markers of inflammation, and oxidative stress in diabetic subjects? BIOMED RESEARCH INTERNATIONAL 2015; 2015:958097. [PMID: 26000307 PMCID: PMC4426896 DOI: 10.1155/2015/958097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/12/2015] [Accepted: 01/27/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES In diabetes accumulated advanced glycation end products (AGEs) are involved in the striking cardiovascular morbidity/mortality. We asked whether a hypovitaminosis D associates with an increased formation and toxicity of AGEs in diabetes. METHODS In 276 diabetics (160 M/116 F, age: 65.0 ± 13.4; 43 type 1,T1DM, and 233 type 2 patients, T2DM) and 121 nondiabetic controls (60 M/61 F; age: 58.6 ± 15.5 years) routine biochemistry, levels of 25-hydroxyvitamin D3 (25-(OH)D), skin autofluorescence (SAF), plasma AGE-associated fluorescence (AGE-FL), N (ε) -(carboxymethyl)lysine (CML), soluble receptor for AGEs (sRAGE), soluble vascular adhesion protein-1 (sVAP-1), high sensitive C-reactive protein (hs-CRP), and renal function (eGFR) were determined. RESULTS In the diabetics SAF and AGE-Fl were higher than those of the controls and correlated with age, duration of diabetes, and degree of renal impairment. In T2DM patients but not in T1DM the age-dependent rise of SAF directly correlated with hs-CRP and sVAP-1. 25-(OH)D levels in diabetics and nondiabetics were lowered to a similar degree averaging 22.5 ng/mL. No relationship between 25-(OH)D and studied markers except for sVAP-1 was observed in the diabetics. CONCLUSION In diabetics hypovitaminosis D does not augment accumulation of AGEs and studied markers of microinflammation and oxidative stress except for sVAP-1.
Collapse
|
72
|
Mandarino NR, Júnior FDCM, Salgado JVL, Lages JS, Filho NS. Is vitamin d deficiency a new risk factor for cardiovascular disease? Open Cardiovasc Med J 2015; 9:40-9. [PMID: 25866591 PMCID: PMC4391213 DOI: 10.2174/1874192401509010040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 01/11/2023] Open
Abstract
The role of vitamin D in the regulation of bone metabolism has been well established. However, in recent years, many studies have demonstrated that its role extends far beyond bone health. Growing evidence has shown a strong association between vitamin D deficiency and hypertension, metabolic syndrome, diabetes mellitus and atherosclerosis. The mechanisms by which vitamin D exerts its cardiovascular protective effects are still not completely understood, but there is evidence that it participates in the regulation of renin-angiotensin system and the mechanisms of insulin sensitivity and activity of inflammatory cytokines, besides its direct cardiovascular actions. In this review, several studies linking vitamin D deficiency with cardiometabolic risk as well as small randomized trials that have evaluated the cardiovascular effects of its supplementation are presented. However, large randomized placebo-controlled studies are still needed before we can definitively establish the role of vitamin D supplementation in the prevention and control of cardiovascular disease.
Collapse
|
73
|
Groves NJ, McGrath JJ, Burne THJ. Vitamin D as a neurosteroid affecting the developing and adult brain. Annu Rev Nutr 2015; 34:117-41. [PMID: 25033060 DOI: 10.1146/annurev-nutr-071813-105557] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Vitamin D deficiency is prevalent throughout the world, and growing evidence supports a requirement for optimal vitamin D levels for the healthy developing and adult brain. Vitamin D has important roles in proliferation and differentiation, calcium signaling within the brain, and neurotrophic and neuroprotective actions; it may also alter neurotransmission and synaptic plasticity. Recent experimental studies highlight the impact that vitamin D deficiency has on brain function in health and disease. In addition, results from recent animal studies suggest that vitamin D deficiency during adulthood may exacerbate underlying brain disorders and/or worsen recovery from brain stressors. An increasing number of epidemiological studies indicate that vitamin D deficiency is associated with a wide range of neuropsychiatric disorders and neurodegenerative diseases. Vitamin D supplementation is readily available and affordable, and this review highlights the need for further research.
Collapse
Affiliation(s)
- Natalie J Groves
- Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland 4072, Australia;
| | | | | |
Collapse
|
74
|
Vitamin D status, hypertension and ischemic stroke: a clinical perspective. J Hum Hypertens 2015; 29:669-74. [PMID: 25810064 DOI: 10.1038/jhh.2015.10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/18/2014] [Accepted: 01/06/2015] [Indexed: 12/29/2022]
Abstract
The relationship between vitamin D deficiency and stroke was cross-sectionally evaluated in the high-risk Asian Indian population. Age- and gender-matched, 239 ischemic stroke patients and 241 control subjects were recruited. Vitamin D status was estimated by measuring serum 25-hydroxyvitamin D (25(OH)D) levels. After multivariate adjustment for a range of potential covariates in a logistic regression model, an inverse association was found between serum 25(OH)D concentration and risk of ischemic stroke: subjects with severely low 25(OH)D levels (⩽9.33 ng ml(-1)) were found to be at 3.13-fold (95% confidence interval (CI), (1.22-8.07)) increased risk of ischemic stroke as compared with those with high levels. Adjustment for systolic blood pressure levels was found to abrogate this association (odds ratio (OR)=2.00, 95% CI=0.61-6.50). On stratification, a pronounced association was found between low 25(OH)D and risk of ischemic stroke in hypertensives, OR=13.54, 95% CI=1.94-94.43 as compared with no association in non-hypertensives, (Pinteraction=0.04). We conclude that high blood pressure partly explains the association between 25(OH)D levels and ischemic stroke. Presence of hypertension amply aggravates the risk of ischemic stroke associated with low vitamin D levels. Meticulous management of hypertension, regular monitoring of serum 25(OH)D levels and treatment of severe vitamin D deficiency, particularly in hypertensive subjects, could help in effective prevention of stroke.
Collapse
|
75
|
Zittermann A, Morshuis M, Kuhn J, Pilz S, Ernst JB, Oezpeker C, Dreier J, Knabbe C, Gummert JF, Milting H. Vitamin D metabolites and fibroblast growth factor-23 in patients with left ventricular assist device implants: association with stroke and mortality risk. Eur J Nutr 2015; 55:305-13. [PMID: 25657014 DOI: 10.1007/s00394-015-0847-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/27/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE Stroke and mortality risk in patients with left ventricular assist device (LVAD) implants continue to be high. Whether nonclassical cardiovascular risk markers such as vitamin D metabolites and fibroblast growth factor (FGF)-23 contribute to this risk remains to be studied, and this was the objective of our work. METHODS In 154 LVAD patients (91 HeartWare and 63 HeartMate II implants), we measured circulating 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D3 (1,25[OH]2D3), parathyroid hormone (PTH) and FGF-23 shortly before LVAD implantation and investigated their association with stroke and mortality risk during 1-year follow-up. RESULTS Of the study cohort, 34.4 and 92.2%, respectively, had deficient 25OHD (<25 nmol/l) and 1,25(OH)2D3 (<41 pmol/l) values, whereas 42.6 and 98.7%, respectively, had elevated PTH levels (>6.7 pmol/l) and FGF-23 values above the reference range (100 RU/ml). One-year freedom from stroke was 80.9 %, and 1-year survival was 64.3%. The multivariable-adjusted hazard ratio of stroke was 2.44 (95% CI: 1.09-5.45; P = 0.03) for the subgroup of 25OHD levels <25 nmol/l (reference group: 25OHD levels ≥25 nmol/l). The multivariable-adjusted hazard ratio of 1-year mortality was 2.78 (95% CI: 1.52-5.09; P = 0.001) for patients with 25OHD levels <25 nmol/l compared with patients with 25OHD levels ≥25 nmol/l. PTH, FGF-23 and 1,25(OH)2D3 were not associated with stroke or mortality risk. CONCLUSIONS In LVAD patients, deficient 25OHD levels are independently associated with high stroke and mortality risk. If confirmed in randomized controlled trials, preoperative correction of deficient vitamin D status could be a promising measure to reduce stroke and mortality risk in LVAD patients.
Collapse
Affiliation(s)
- A Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
| | - M Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - J Kuhn
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - S Pilz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - J B Ernst
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - C Oezpeker
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - J Dreier
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - C Knabbe
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - J F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - H Milting
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.,Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
76
|
Stagi S, Lapi E, Romano S, Bargiacchi S, Brambilla A, Giglio S, Seminara S, de Martino M. Determinants of vitamin d levels in children and adolescents with down syndrome. Int J Endocrinol 2015; 2015:896758. [PMID: 25685147 PMCID: PMC4320854 DOI: 10.1155/2015/896758] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/28/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Poor studies have evaluated 25-hydroxycholecalciferol (25(OH)D) levels in Down syndrome (DS). Objective. To assess in DS subjects serum 25(OH)D value, to identify risk factors for vitamin D deficiency, and to evaluate whether a normal 25(OH)D value can be restored with a 400 I.U. daily supplement of cholecalciferol in respect to controls. Methods. We have longitudinally evaluated 31 DS patients (aged 4.5-18.9 years old) and 99 age- and sex-matched healthy controls. In these subjects, we analysed calcium, phosphate, parathyroid hormone (PTH), 25(OH)D concentrations, and calcium and 25(OH)D dietary intakes, and we quantified outdoor exposure. After 12.3 months (range 8.1-14.7 months) of 25(OH)D supplementation, we reevaluated these subjects. Results. DS subjects showed reduced 25(OH)D levels compared to controls (P < 0.0001), in particular DS subjects with obesity (P < 0.05) and autoimmune diseases history (P < 0.005). PTH levels were significantly higher in DS subjects than controls (P < 0.0001). After cholecalciferol supplementation, 25(OH)D levels were significantly ameliorated (P < 0.05), even if reduced compared to controls (P < 0.0001), in particular in DS subjects with obesity (P < 0.05) and autoimmune diseases (P < 0.001). Conclusions. Hypovitaminosis D is very frequent in DS subjects, in particular in presence of obesity and autoimmune diseases. In these subjects, there could be a need for higher cholecalciferol supplementation.
Collapse
Affiliation(s)
- Stefano Stagi
- Health Sciences Department, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
- *Stefano Stagi:
| | - Elisabetta Lapi
- Genetics and Molecular Medicine Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Silvia Romano
- Genetics and Molecular Medicine Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Sara Bargiacchi
- Genetics and Molecular Medicine Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Alice Brambilla
- Health Sciences Department, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Sabrina Giglio
- Genetics and Molecular Medicine Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Salvatore Seminara
- Health Sciences Department, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Maurizio de Martino
- Health Sciences Department, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| |
Collapse
|
77
|
Barassi A, Pezzilli R, Colpi GM, Corsi Romanelli MM, Melzi d'Eril GV. Vitamin D and Erectile Dysfunction. J Sex Med 2014; 11:2792-800. [DOI: 10.1111/jsm.12661] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
78
|
Kleber ME, Goliasch G, Grammer TB, Pilz S, Tomaschitz A, Silbernagel G, Maurer G, März W, Niessner A. Evolving biomarkers improve prediction of long-term mortality in patients with stable coronary artery disease: the BIO-VILCAD score. J Intern Med 2014; 276:184-94. [PMID: 25184160 DOI: 10.1111/joim.12189] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Algorithms to predict the future long-term risk of patients with stable coronary artery disease (CAD) are rare. The VIenna and Ludwigshafen CAD (VILCAD) risk score was one of the first scores specifically tailored for this clinically important patient population. The aim of this study was to refine risk prediction in stable CAD creating a new prediction model encompassing various pathophysiological pathways. Therefore, we assessed the predictive power of 135 novel biomarkers for long-term mortality in patients with stable CAD. DESIGN, SETTING AND SUBJECTS We included 1275 patients with stable CAD from the LUdwigshafen RIsk and Cardiovascular health study with a median follow-up of 9.8 years to investigate whether the predictive power of the VILCAD score could be improved by the addition of novel biomarkers. Additional biomarkers were selected in a bootstrapping procedure based on Cox regression to determine the most informative predictors of mortality. RESULTS The final multivariable model encompassed nine clinical and biochemical markers: age, sex, left ventricular ejection fraction (LVEF), heart rate, N-terminal pro-brain natriuretic peptide, cystatin C, renin, 25OH-vitamin D3 and haemoglobin A1c. The extended VILCAD biomarker score achieved a significantly improved C-statistic (0.78 vs. 0.73; P = 0.035) and net reclassification index (14.9%; P < 0.001) compared to the original VILCAD score. Omitting LVEF, which might not be readily measureable in clinical practice, slightly reduced the accuracy of the new BIO-VILCAD score but still significantly improved risk classification (net reclassification improvement 12.5%; P < 0.001). CONCLUSION The VILCAD biomarker score based on routine parameters complemented by novel biomarkers outperforms previous risk algorithms and allows more accurate classification of patients with stable CAD, enabling physicians to choose more personalized treatment regimens for their patients.
Collapse
Affiliation(s)
- M. E. Kleber
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology); Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Department of Internal Medicine II - Cardiology; University of Ulm Medical Centre; Ulm Germany
| | - G. Goliasch
- Division of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
- Zena and Michael A. Wiener Cardiovascular Institute; Mount Sinai School of Medicine; New York NY USA
| | - T. B. Grammer
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology); Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - S. Pilz
- Division of Endocrinology and Metabolism; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - A. Tomaschitz
- Division of Cardiology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - G. Silbernagel
- Department of Angiology; Swiss Cardiovascular Center; Inselspital; University of Bern Switzerland
| | - G. Maurer
- Division of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | - W. März
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology); Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics; Medical University of Graz; Graz Austria
- Synlab Academy; Synlab Services GmbH; Mannheim Germany
| | - A. Niessner
- Division of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| |
Collapse
|
79
|
Selting KA, Sharp CR, Ringold R, Thamm DH, Backus R. Serum 25‐hydroxyvitamin D concentrations in dogs – correlation with health and cancer risk. Vet Comp Oncol 2014; 14:295-305. [DOI: 10.1111/vco.12101] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 04/07/2014] [Accepted: 05/09/2014] [Indexed: 01/08/2023]
Affiliation(s)
- K. A. Selting
- Veterinary Medical Teaching Hospital University of Missouri Columbia MO USA
| | - C. R. Sharp
- Cummings School of Veterinary Medicine Tufts University North Grafton MA USA
| | - R. Ringold
- Veterinary Diagnostics Institute Simi Valley CA USA
| | - D. H. Thamm
- Department of Clinical Sciences, Animal Cancer Center Colorado State University Fort Collins CO USA
| | - R. Backus
- Veterinary Medical Teaching Hospital University of Missouri Columbia MO USA
| |
Collapse
|
80
|
Khademvatani K, Seyyed-Mohammadzad MH, Akbari M, Rezaei Y, Eskandari R, Rostamzadeh A. The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis. Int J Gen Med 2014; 7:303-9. [PMID: 24971035 PMCID: PMC4069050 DOI: 10.2147/ijgm.s64812] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Vitamin D has been shown to have an anticoagulant effect. A decrease in 25-hydroxyvitamin D [25(OH)D] concentration has also been associated with an increased risk of venous thromboembolism. Hence, we sought to determine the relationship between 25(OH) D levels and idiopathic lower-extremity deep vein thrombosis (DVT). Methods In a case control study, a total of 82 participants with idiopathic lower-extremity DVT were enrolled along with 85 sex- and age-matched healthy participants as controls. The plasma 25(OH)D levels were measured in all the studied samples. Results The participants’ mean age was 47.1±12.3 years. Baseline characteristics were not significantly different between the groups. The concentration of 25(OH)D was significantly lower in the DVT group compared to that of the control group (17.9±10.3 versus 23.1±12.5 ng/mL, P=0.004). The prevalence of participants with deficient 25(OH)D levels was significantly higher in the both DVT and control groups than those with sufficient 25(OH)D levels (68.3% versus 13.4%, and 49.4% versus 28.2%, respectively, P=0.027). In a multivariate analysis, 25(OH)D levels and sex were found to be the only independent predictors of DVT (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.08, P=0.001 and OR 0.51, 95% CI 0.26–1.00, P=0.049, respectively). Conclusion Low levels of 25(OH)D are associated with idiopathic lower-extremity DVT. Further investigation is needed to establish determinants and probable causative role of 25(OH)D.
Collapse
Affiliation(s)
- Kamal Khademvatani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Mohammad Akbari
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Yousef Rezaei
- Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Ramin Eskandari
- Department of Cardiology, Firoozgar Hospital, Iran University of Medial Sciences, Tehran, Iran
| | - Alireza Rostamzadeh
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
81
|
Kent ST, Cushman M, Howard G, Judd SE, Crosson WL, Al-Hamdan MZ, McClure LA. Sunlight exposure and cardiovascular risk factors in the REGARDS study: a cross-sectional split-sample analysis. BMC Neurol 2014; 14:133. [PMID: 24946776 PMCID: PMC4075775 DOI: 10.1186/1471-2377-14-133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 06/13/2014] [Indexed: 12/31/2022] Open
Abstract
Background Previous research has suggested that vitamin D and sunlight are related to cardiovascular outcomes, but associations between sunlight and risk factors have not been investigated. We examined whether increased sunlight exposure was related to improved cardiovascular risk factor status. Methods Residential histories merged with satellite, ground monitor, and model reanalysis data were used to determine previous-year sunlight radiation exposure for 17,773 black and white participants aged 45+ from the US. Exploratory and confirmatory analyses were performed by randomly dividing the sample into halves. Logistic regression models were used to examine relationships with cardiovascular risk factors. Results The lowest, compared to the highest quartile of insolation exposure was associated with lower high-density lipoprotein levels in adjusted exploratory (−2.7 mg/dL [95% confidence interval: −4.2, −1.2]) and confirmatory (−1.5 mg/dL [95% confidence interval: −3.0, −0.1]) models. The lowest, compared to the highest quartile of insolation exposure was associated with higher systolic blood pressure levels in unadjusted exploratory and confirmatory, as well as the adjusted exploratory model (2.3 mmHg [95% confidence interval: 0.8, 3.8]), but not the adjusted confirmatory model (1.6 mg/dL [95% confidence interval: −0.5, 3.7]). Conclusions The results of this study suggest that lower long-term sunlight exposure has an association with lower high-density lipoprotein levels. However, all associations were weak, thus it is not known if insolation may affect cardiovascular outcomes through these risk factors.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Leslie A McClure
- Department of Biostatistics, 1665 University Blvd, University of Alabama at Birmingham, Birmingham 35294, Alabama.
| |
Collapse
|
82
|
Scrimgeour AG, Condlin ML. Nutritional Treatment for Traumatic Brain Injury. J Neurotrauma 2014; 31:989-99. [DOI: 10.1089/neu.2013.3234] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Angus G. Scrimgeour
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Michelle L. Condlin
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| |
Collapse
|
83
|
Robertsen S, Grimnes G, Melbye H. Association between serum 25-hydroxyvitamin D concentration and symptoms of respiratory tract infection in a Norwegian population: the Tromsø Study. Public Health Nutr 2014; 17:780-6. [PMID: 23659381 PMCID: PMC10282290 DOI: 10.1017/s1368980013001134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 01/14/2013] [Accepted: 03/15/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have suggested anti-infection effects of vitamin D, although the associations reported between vitamin D (serum 25-hydroxyvitamin D (25(OH)D) concentration) and respiratory tract infection (RTI) are conflicting. The main aim of the present study was to explore this association in a Norwegian population. DESIGN We examined the association between serum 25(OH)D and recent RTI symptoms in 6350 middle-aged and elderly participants in the Tromsø Study 6. The main outcome measurement was self-reported RTI symptoms in the previous week. SETTING Tromsø, Norway, 69 °N. SUBJECTS Six thousand three hundred and fifty middle-aged and elderly residents of Tromsø. RESULTS Of the 6350 included, 791 (12.5%) reported RTI symptoms in the previous week. We classified serum 25(OH)D concentrations into quartiles and adjusted the data for current smoking habit and month of attendance. The prevalence of RTI symptoms did not increase with decreasing serum 25(OH)D level, was highest in quartile 3 (15.0%) followed by quartile 4 (12.4%), and was lowest in quartiles 1 and 2 (11.1% and 11.4%). There was no trend for increasing duration of illness with decreasing serum 25(OH)D. The prevalence of RTI symptoms was not significantly associated with the intake of fish, n-3 capsules or vitamin and/or mineral supplements, or sun exposure. Only use of cod-liver oil or fish oil capsules daily or sometimes was significantly associated with fewer RTI symptoms during the preceding 7 d (P = 0.04). CONCLUSIONS Low serum 25(OH)D was not associated with increased prevalence of recent RTI symptoms. Our findings do not support the idea that vitamin D supplementation can reduce the incidence of RTI in Norway.
Collapse
Affiliation(s)
- Steinar Robertsen
- General Practice Research Unit, Department of Community Medicine, MH-building, Faculty of Health Science, University of Tromsø, 9037 Tromsø, Norway
| | - Guri Grimnes
- Tromsø Endocrine Research Group, Department of Clinical Medicine, Faculty of Health Science, University of Tromsø and Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, MH-building, Faculty of Health Science, University of Tromsø, 9037 Tromsø, Norway
| |
Collapse
|
84
|
Tu WJ, Zhao SJ, Xu DJ, Chen H. Serum 25-hydroxyvitamin D predicts the short-term outcomes of Chinese patients with acute ischaemic stroke. Clin Sci (Lond) 2014; 126:339-346. [PMID: 24020395 DOI: 10.1042/cs20130284] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Low vitamin D levels have been reported to contribute to the risk of cardiovascular events and mortality, especially stroke. In the present study we therefore evaluated the short-term prognostic value of serum 25(OH)D (25-hydroxyvitamin D) in Chinese patients with AIS (acute ischaemic stroke). From February 2010 to September 2012, consecutive stroke patients admitted to the emergency department at two hospitals in Beijing, China were identified. Clinical information was collected, and the serum concentration of 25(OH)D and NIHSS (National Institutes of Health Stroke Scale) were measured at the time of admission. Short-term functional outcome was measured using a modified Rankin Scale (mRS) at 90 days after admission. Multivariate analyses were performed using logistic regression models. During the inclusion period, 231 patients were diagnosed as having AIS, and 220 completed follow-up. The median serum 25(OH)D level was significantly lower in patients with AIS compared with normal controls [14.2 (10.2-18.9) ng/ml compared with 17.9 (12.5-22.9) ng/ml; P<0.001; values are medians (interquartile range)]. 25(OH)D was an independent prognostic marker of short-term functional outcome and death {0.79 (0.73-0.85) and 0.70 (0.50-0.98) respectively [values are odds rations (95% confidence intervals)]; P<0.01 for both, adjusted for NHISS, other predictors and vascular risk factors} in patients with AIS. In ROC (receiver operating characteristic) curve analysis, the prognostic accuracy of 25(OH)D was higher compared with all of the other serum predictors and was in the range of NIHSS score. In conclusion, these findings suggest that 25(OH)D is an independent prognostic marker for death and functional outcome within 90 days in Chinese patients with AIS even after adjusting for possible confounding factors.
Collapse
Affiliation(s)
- Wen-Jun Tu
- ‡Department of Neurology, China Rehabilitation Research Center, Beijing, P.R. China
| | | | | | | |
Collapse
|
85
|
Drechsler C, Schmiedeke B, Niemann M, Schmiedeke D, Krämer J, Turkin I, Blouin K, Emmert A, Pilz S, Obermayer-Pietsch B, Weidemann F, Breunig F, Wanner C. Potential role of vitamin D deficiency on Fabry cardiomyopathy. J Inherit Metab Dis 2014; 37:289-95. [PMID: 24141790 PMCID: PMC3976508 DOI: 10.1007/s10545-013-9653-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/29/2013] [Accepted: 08/26/2013] [Indexed: 12/22/2022]
Abstract
Patients with Fabry disease frequently develop left ventricular (LV) hypertrophy and renal fibrosis. Due to heat intolerance and an inability to sweat, patients tend to avoid exposure to sunlight. We hypothesized that subsequent vitamin D deficiency may contribute to Fabry cardiomyopathy. This study investigated the vitamin D status and its association with LV mass and adverse clinical symptoms in patients with Fabry disease. 25-hydroxyvitamin D (25[OH]D) was measured in 111 patients who were genetically proven to have Fabry disease. LV mass and cardiomyopathy were assessed by magnetic resonance imaging and echocardiography. In cross-sectional analyses, associations with adverse clinical outcomes were determined by linear and binary logistic regression analyses, respectively, and were adjusted for age, sex, BMI and season. Patients had a mean age of 40 ± 13 years (42% males), and a mean 25(OH)D of 23.5 ± 11.4 ng/ml. Those with overt vitamin D deficiency (25[OH]D ≤ 15 ng/ml) had an adjusted six fold higher risk of cardiomyopathy, compared to those with sufficient 25(OH)D levels >30 ng/ml (p = 0.04). The mean LV mass was distinctively different with 170 ± 75 g in deficient, 154 ± 60 g in moderately deficient and 128 ± 58 g in vitamin D sufficient patients (p = 0.01). With increasing severity of vitamin D deficiency, the median levels of proteinuria increased, as well as the prevalences of depression, edema, cornea verticillata and the need for medical pain therapy. In conclusion, vitamin D deficiency was strongly associated with cardiomyopathy and adverse clinical symptoms in patients with Fabry disease. Whether vitamin D supplementation improves complications of Fabry disease, requires a randomized controlled trial.
Collapse
Affiliation(s)
- Christiane Drechsler
- Department of Medicine 1, Divisions of Nephrology and Cardiology, University Hospital Würzburg, Würzburg, Germany,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
86
|
Ellam T, Hameed A, ul Haque R, Muthana M, Wilkie M, Francis SE, Chico TJA. Vitamin D deficiency and exogenous vitamin D excess similarly increase diffuse atherosclerotic calcification in apolipoprotein E knockout mice. PLoS One 2014; 9:e88767. [PMID: 24586387 PMCID: PMC3929524 DOI: 10.1371/journal.pone.0088767] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/15/2014] [Indexed: 01/12/2023] Open
Abstract
Background Observational data associate lower levels of serum vitamin D with coronary artery calcification, cardiovascular events and mortality. However, there is little interventional evidence demonstrating that moderate vitamin D deficiency plays a causative role in cardiovascular disease. This study examined the cardiovascular effects of dietary vitamin D deficiency and of vitamin D receptor agonist (paricalcitol) administration in apolipoprotein E knockout mice. Methods Mice were fed atherogenic diets with normal vitamin D content (1.5IU/kg) or without vitamin D. Paricalcitol, or matched vehicle, was administered 3× weekly by intraperitoneal injection. Following 20 weeks of these interventions cardiovascular phenotype was characterized by histological assessment of aortic sinus atheroma, soluble markers, blood pressure and echocardiography. To place the cardiovascular assessments in the context of intervention effects on bone, structural changes at the tibia were assessed by microtomography. Results Vitamin D deficient diet induced significant reductions in plasma vitamin D (p<0.001), trabecular bone volume (p<0.01) and bone mineral density (p<0.005). These changes were accompanied by an increase in calcification density (number of calcifications per mm2) of von Kossa-stained aortic sinus atheroma (461 versus 200, p<0.01). Paricalcitol administration suppressed parathyroid hormone (p<0.001), elevated plasma calcium phosphate product (p<0.005) and induced an increase in calcification density (472 versus 200, p<0.005) similar to that seen with vitamin D deficiency. Atheroma burden, blood pressure, metabolic profile and measures of left ventricular hypertrophy were unaffected by the interventions. Conclusion Vitamin D deficiency, as well as excess, increases atherosclerotic calcification. This phenotype is induced before other measures of cardiovascular pathology associated clinically with vitamin D deficiency. Thus, maintenance of an optimal range of vitamin D signalling may be important for prevention of atherosclerotic calcification.
Collapse
Affiliation(s)
- Timothy Ellam
- Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
- * E-mail:
| | - Abdul Hameed
- Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
| | - Risat ul Haque
- Department of Infection and Immunity, University of Sheffield, Sheffield, United Kingdom
| | - Munitta Muthana
- Department of Infection and Immunity, University of Sheffield, Sheffield, United Kingdom
| | - Martin Wilkie
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Sheila E. Francis
- Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
| | - Timothy J. A. Chico
- Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
87
|
Tsuda K. Letter by Tsuda regarding article, "Serum alkaline phosphatase and phosphate in cerebral atherosclerosis and functional outcomes after cerebral infarction". Stroke 2014; 45:e46. [PMID: 24448990 DOI: 10.1161/strokeaha.113.004276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kazushi Tsuda
- Cardiovascular Medicine, Cardiovascular and Metabolic Research Center, Kansai University of Health Sciences, Osaka, Japan
| |
Collapse
|
88
|
Chaudhuri JR, Mridula KR, Alladi S, Anamika A, Umamahesh M, Balaraju B, Swath A, Bandaru VCSS. Serum 25-hydroxyvitamin d deficiency in ischemic stroke and subtypes in Indian patients. J Stroke 2014; 16:44-50. [PMID: 24741564 PMCID: PMC3961818 DOI: 10.5853/jos.2014.16.1.44] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/25/2013] [Accepted: 11/28/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Vitamin D deficiency is common across all age groups and may contribute to cardiovascular diseases. Serum 25-hydroxyvitamin D deficiency causing ischemic stroke has been documented in recent reports. AIM To investigate the association of serum 25-hydroxyvitamin D deficiency with ischemic stroke and subtypes. METHODS We recruited 250 consecutive ischemic stroke patients and 250 age and sex matched controls attending the Department of Neurology, at Yashoda hospital, Hyderabad, India, from January 2011 to December 2012. All ischemic stroke patients underwent stroke subtyping. We measured 25-hydroxyvitamin D by chemiluminescence test, serum calcium, phosphorus, alkaline phosphatase, and C-reactive protein (CRP) in cases and controls. RESULTS Out of 250 stroke patients, 190 (76%) were men and mean age was 58.4±11.1 years (age range-26-89 years). 25-hydroxyvitamin D deficiency was observed in 122 (48.8%) stroke patients and 79 (31.6%) controls (P=0.001). Among stroke patients, serum 25-hydroxyvitamin D deficiency was found in 54.9% (50/91) of patients with large artery atherosclerosis, 54% (20/37) in cardioembolic stroke, 44.4% (20/45) in small artery diseases, 42.8% (15/35) in stroke of other determined etiology and 40.4% (17/42) in stroke of un-determined etiology. Multiple logistic regression analysis showed an independent association of 25-hydroxyvitamin D deficiency with ischemic stroke (odds ratio: 1.6; 95% CI 1.2-2.8). The association was strongest with large artery atherosclerosis (odds ratio: 2.4; 95% CI 1.6-3.5) and cardioembolic stroke (odds ratio: 2.0; 95% CI 1.0-3.2). CONCLUSIONS We found that 25-hydroxyvitamin D deficiency had an independent association with ischemic stroke. The association was established in large artery arthrosclerosis and cardioembolic stroke.
Collapse
Affiliation(s)
| | - K. Rukmini Mridula
- Department of Neurology, Nizam's Institution of Medical Sciences, Hyderabad, India
| | - Suvarna Alladi
- Department of Neurology, Nizam's Institution of Medical Sciences, Hyderabad, India
| | - A. Anamika
- Department of Biochemistry, Yashoda Hospital, Hyderabad, India
| | - M. Umamahesh
- Department of Radiology, Yashoda Hospital Hyderabad, India
| | - Banda Balaraju
- Department of Medicine, Yashoda Hospital, Hyderabad, India
| | - A. Swath
- Department of Neurology, Yashoda Hospital, Hyderabad, India
| | - VCS Srinivasarao Bandaru
- Department of Neurology, Yashoda Hospital, Hyderabad, India
- Department of Clinical Research, Yashoda Hospital, Hyderabad, India
| |
Collapse
|
89
|
Park JM, Lee SG, Park EK, Lee DS, Baek SM, Hwang KL, Kim JK, Park JH, Kim GT, Choi SY. Association between Vitamin D Deficiency and Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.3.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jong-Man Park
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Seung-Geun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Eun-Kyoung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Dae-Sung Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Sung-Min Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Kyung-Lim Hwang
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Joong-Keun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Ji-Heh Park
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Geun-Tae Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seon-Yoon Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
90
|
Poststroke hip fracture: prevalence, clinical characteristics, mineral-bone metabolism, outcomes, and gaps in prevention. Stroke Res Treat 2013; 2013:641943. [PMID: 24187647 PMCID: PMC3800649 DOI: 10.1155/2013/641943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/06/2013] [Accepted: 08/20/2013] [Indexed: 01/07/2023] Open
Abstract
Objective. To assess the prevalence, clinical and laboratory characteristics, and short-term outcomes of poststroke hip fracture (HF). Methods. A cross-sectional study of 761 consecutive patients aged ≥60 years (82.3 ± 8.8 years; 75% females) with osteoporotic HF. Results. The prevalence of poststroke HF was 13.1% occurring on average 2.4 years after the stroke. The poststroke group compared to the rest of the cohort had a higher proportion of women, subjects with dementia, history of TIA, hypertension, coronary artery disease, secondary hyperparathyroidism, higher serum vitamin B12 levels (>350 pmol/L), walking aid users, and living in residential care facilities. The majority of poststroke HF patients had vitamin D insufficiency (68%) and excess bone resorption (90%). This group had a 3-fold higher incidence of postoperative myocardial injury and need for institutionalisation. In multivariate analysis, independent indicators of poststroke HF were female sex (OR 3.6), history of TIA (OR 5.2), dementia (OR 4.1), hypertension (OR 3.2), use of walking aid (OR 2.5), and higher vitamin B12 level (OR 2.3). Only 15% of poststroke patients received antiosteoporotic therapy prior to HF. Conclusions. Approximately one in seven HFs occurs in older stroke survivors and are associated with poorer outcomes. Early implementation of fracture prevention strategies is needed.
Collapse
|
91
|
Arora M, Kaul D, Sharma YP. Blood cellular mutant LXR-α protein stability governs initiation of coronary heart disease. World J Cardiol 2013; 5:305-312. [PMID: 24009820 PMCID: PMC3761184 DOI: 10.4330/wjc.v5.i8.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/29/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the role of [breast and ovarian cancer susceptibility 1 (BRCA1)-associated RING domain 1 (BARD1)]/BRCA1 E3-ubiquitin ligase complex in governing the stability of mutant liver X receptor-α (LXR-α) protein in coronary heart disease (CHD) subjects.
METHODS: The expression analysis of various genes was carried out by quantitative real time polymerase chain reaction and western blotting within blood mononuclear cells of human CHD subjects at various stages of coronary occlusion and their corresponding normal healthy counterparts. Immunoprecipitation experiments were performed to establish protein interactions between LXR-α and BARD1. Peripheral blood mononuclear cells were cultured and exposed to Vitamin D3 and Cisplatin to validate the degradation of mutant LXR-α protein in CHD subjects by BARD1/BRCA1 complex.
RESULTS: The expression of mutant LXR-α protein in CHD subjects was found to decrease gradually with the severity of coronary occlusion exhibiting a strong negative correlation, r = -0.975 at P < 0.001. Further, the expression of BARD1 and BRCA1 also increased with the disease severity, r = 0.895 and 0.873 respectively (P < 0.001). Immunoprecipitation studies established that BARD1/BRCA1 complex degrades mutant LXR-αvia ubiquitination. The absence of functional LXR-α protein resulted in increased expression of inflammatory cytokines such as interleukin (IL)-6, IL-8 and interferon-γ and decreased expression of ABCA1 (ATP-binding cassette A1) (r = 0.932, 0.949, 0.918 and -0.902 with respect to Gensini score; P < 0.001). Additionally, cell culture experiments proved that Vitamin D3 could prevent the degradation of mutant LXR-α and restore its functional activity to some extent.
CONCLUSION: Mutant LXR-α protein in CHD subjects is degraded by BARD1/BRCA1 complex and Vitamin D3 can rescue and restore its function.
Collapse
|
92
|
|
93
|
Abstract
The actions of vitamin D are not confined to bone. Vitamin D receptors are present in nearly all the nuclei and its actions are manifold. Populations deficient in vitamin D are at higher risk of developing autoimmune diseases, diabetes, cancer, infections, allergies and other chronic illnesses.
Collapse
Affiliation(s)
- R. Kasi Visweswaran
- Department of Nephrology, Ananthapuri Hospitals and Research Institute, NH Bypass, Chackai, Trivandrum, India
| | - H. Lekha
- Department of Nephrology, Ananthapuri Hospitals and Research Institute, NH Bypass, Chackai, Trivandrum, India
| |
Collapse
|
94
|
Vitamin D Deficiency in Early Life and the Potential Programming of Cardiovascular Disease in Adulthood. J Cardiovasc Transl Res 2013; 6:588-603. [DOI: 10.1007/s12265-013-9475-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/14/2013] [Indexed: 01/17/2023]
|
95
|
Dave VP, Kaul D. Heart and Brain: A neutro-genomic link. World J Biol Chem 2013; 4:16-17. [PMID: 23710295 PMCID: PMC3652646 DOI: 10.4331/wjbc.v4.i2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/15/2013] [Accepted: 04/29/2013] [Indexed: 02/05/2023] Open
Abstract
The philosophy of heart and brain are very ancient in our literature where the things good for the heart are not suggested good for the brain and vice-versa. Modern medicine is characterized by a high degree of specialization and the heart-brain connection that could be targeted to treat these complex cardiovascular/brain disorders. The idea that adverse diet/genome interactions can cause disease is not new. In the recent era the science of nutritional genomics have increased our understanding of diet-health-gene interactions and have provided a number of benefits for individuals, groups and societies. Since dietary chemicals are regularly ingested and participate indirectly and directly in regulating gene expression, it follows that a subset of genes regulated by diet must be involved in disease initiation, progression, and severity. In this regards Liver X Receptor (LXR)-α, a key transcription factors, associated with the several chronic pathological situation including coronary heart disease and neurodegenerative diseases have recently been found to be regulated by the dietary components. The crucial findings at molecular biology unit, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA have not only forced us to explore nutritional genomics as a holistic systems approach to understand the relationship between diet and health, but also to look into the disease preventing and health promoting foods that match our lifestyles, cultures and genetics. After all, we are what we eat.
Collapse
|
96
|
Vitamin D, calcium, and atherosclerotic risk: evidence from serum levels and supplementation studies. Curr Atheroscler Rep 2013; 15:293. [PMID: 23232985 DOI: 10.1007/s11883-012-0293-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vitamin D and calcium have traditionally been viewed in relation to bone health. However, recent research has suggested relations between these nutrients and cardiovascular disease (CVD). Specifically, evidence from both observational studies and clinical trials suggests that vitamin D may be related to lower risk of CVD. The picture for calcium is more complex. Dietary intake of calcium may be associated with lower CVD risk, while calcium supplementation may elevate CVD risk. In this review, we summarize evidence of these relations, and comment on the recent Institute of Medicine (IOM) recommendations regarding use of vitamin D and calcium supplements.
Collapse
|
97
|
Brøndum-Jacobsen P, Benn M, Tybjaerg-Hansen A, Nordestgaard BG. 25-Hydroxyvitamin D concentrations and risk of venous thromboembolism in the general population with 18,791 participants. J Thromb Haemost 2013; 11:423-31. [PMID: 23279309 DOI: 10.1111/jth.12118] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/13/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Vitamin D has potential antithrombotic effects, suggesting that vitamin D analogs could be used as adjunctive antithrombotic agents. However, epidemiologic evidence of an association between reduced 25-hydroxyvitamin D concentrations and the risk of venous thromboembolism is lacking. OBJECTIVES To test the hypothesis that reduced plasma 25-hydroxyvitamin D concentrations are associated with an increased risk of venous thromboembolism in the general population. METHODS We prospectively studied 18 791 participants from the Copenhagen City Heart Study and the Copenhagen General Population Study. During up to 30 years of follow-up, 950 participants were diagnosed with venous thromboembolism. Plasma 25-hydroxyvitamin D concentrations were adjusted for seasonal variation. RESULTS The cumulative incidence of venous thromboembolism as a function of age increased with decreasing tertiles of seasonally adjusted plasma 25-hydroxyvitamin D (log-rank trend: P = 4 × 10(-4) ). On comparison of participants in the lowest and the highest tertile of plasma 25-hydroxyvitamin D concentrations, the crude risk estimate in a model adjusted for age and sex was a 37% (95% confidence interval [CI] 15-64%) increased risk of venous thromboembolism. The corresponding risk increase in a model adjusted for age, sex, body mass index, smoking and cancer was 26% (95% CI 5-51%), and in a multivariable-adjusted model also including physical activity, hormone replacement therapy, menopausal status, oral contraception use and lipid-lowering therapy it was 28% (95% CI 6-53%). Furthermore, corresponding risk increases with attempts to correct for regression dilution bias were 103% (95% CI 37-202%), 70% (95% CI 14-155%) and 73% (95% CI 15-160%) in the three models, respectively. CONCLUSION In these large general population studies, we observed a stepwise increasing risk of venous thromboembolism with decreasing tertiles of seasonally adjusted plasma 25-hydroxyvitamin D concentrations.
Collapse
Affiliation(s)
- P Brøndum-Jacobsen
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | | | | | | |
Collapse
|
98
|
Sohrabji F, Selvamani A, Balden R. Revisiting the timing hypothesis: biomarkers that define the therapeutic window of estrogen for stroke. Horm Behav 2013; 63:222-30. [PMID: 22728278 PMCID: PMC3483414 DOI: 10.1016/j.yhbeh.2012.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 02/06/2023]
Abstract
Significantly extended life expectancy coupled with contemporary sedentary lifestyles and poor nutrition has created a global epidemic of cardiovascular disease and stroke. For women, this issue is complicated by the discrepant outcomes of hormone therapy (HT) for stroke incidence and severity as well as the therapeutic complications for stroke associated with advancing age. Here we propose that the impact of estrogen therapy cannot be considered in isolation, but should include age-related changes in endocrine, immune, and nucleic acid mediators that collaborate with estrogen to produce neuroprotective effects commonly seen in younger, healthier demographics. Due to their role as modulators of ischemic cell death, the post-stroke inflammatory response, and neuronal survival and regeneration, this review proposes that Insulin-like Growth Factor (IGF)-1, Vitamin D, and discrete members of the family of non-coding RNA peptides called microRNAs (miRNAs) may be crucial biochemical markers that help determine the neuroprotective "window" of HT. Specifically, IGF-1 confers neuroprotection in concert with, and independently of, estrogen and failure of the insulin/IGF-1 axis is associated with metabolic disturbances that increase the risk for stroke. Vitamin D and miRNAs regulate and complement IGF-1 mediated function and neuroprotective efficacy via modulation of IGF-1 availability and neural stem cell and immune cell proliferation, differentiation and secretions. Together, age-related decline of these factors differentially affects stroke risk, severity, and outcome, and may provide a novel therapeutic adjunct to traditional HT practices.
Collapse
Affiliation(s)
- Farida Sohrabji
- Department of Neuroscience and Experimental Therapeutics, Women's Health in Neuroscience Program, Texas A&M Health Science Center, College Station, TX 77843-1114, USA.
| | | | | |
Collapse
|
99
|
Zittermann A, Kuhn J, Dreier J, Knabbe C, Gummert JF, Borgermann J. Vitamin D status and the risk of major adverse cardiac and cerebrovascular events in cardiac surgery. Eur Heart J 2013; 34:1358-64. [DOI: 10.1093/eurheartj/ehs468] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
100
|
Kent ST, McClure LA, Judd SE, Howard VJ, Crosson WL, Al-Hamdan MZ, Wadley VG, Peace F, Kabagambe EK. Short- and long-term sunlight radiation and stroke incidence. Ann Neurol 2013; 73:32-7. [PMID: 23225379 PMCID: PMC3563869 DOI: 10.1002/ana.23737] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/17/2012] [Accepted: 08/10/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Examine whether long- and short-term sunlight radiation is related to stroke incidence. METHODS Fifteen-year residential histories merged with satellite, ground monitor, and model reanalysis data were used to determine sunlight radiation (insolation) and temperature exposure for a cohort of 16,606 stroke and coronary artery disease-free black and white participants aged ≥45 years from the 48 contiguous United States. Fifteen-, 10-, 5-, 2-, and 1-year exposures were used to predict stroke incidence during follow-up in Cox proportional hazard models. Potential confounders and mediators were included during model building. RESULTS Shorter exposure periods exhibited similar, but slightly stronger relationships than longer exposure periods. After adjustment for other covariates, the previous year's monthly average insolation exposure below the median gave a hazard ratio (HR) of 1.61 (95% confidence interval [CI], 1.15-2.26), and the previous year's highest compared to the second highest quartile of monthly average maximum temperature exposure gave an HR of 1.92 (95%, 1.27-2.92). INTERPRETATION These results indicate a relationship between lower levels of sunlight radiation and higher stroke incidence. The biological pathway of this relationship is not clear. Future research will show whether this finding stands, the pathway for this relationship, and whether it is due to short- or long-term exposures.
Collapse
Affiliation(s)
- Shia T Kent
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|