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Wang D, Sun Z, Yin Y, Xiang J, Wei Y, Ma Y, Wang L, Liu G. Vitamin D and Atherosclerosis: Unraveling the Impact on Macrophage Function. Mol Nutr Food Res 2024; 68:e2300867. [PMID: 38864846 DOI: 10.1002/mnfr.202300867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/02/2024] [Indexed: 06/13/2024]
Abstract
Vitamin D plays a crucial role in preventing atherosclerosis and in the regulation of macrophage function. This review aims to provide a comprehensive summary of the clinical evidence regarding the impact of vitamin D on atherosclerotic cardiovascular disease, atherosclerotic cerebrovascular disease, peripheral arterial disease, and associated risk factors. Additionally, it explores the mechanistic studies investigating the influence of vitamin D on macrophage function in atherosclerosis. Numerous findings indicate that vitamin D inhibits monocyte or macrophage recruitment, macrophage cholesterol uptake, and esterification. Moreover, it induces autophagy of lipid droplets in macrophages, promotes cholesterol efflux from macrophages, and regulates macrophage polarization. This review particularly focuses on analyzing the molecular mechanisms and signaling pathways through which vitamin D modulates macrophage function in atherosclerosis. It claims that vitamin D has a direct inhibitory effect on the formation, adhesion, and migration of lipid-loaded monocytes, thus exerting anti-atherosclerotic effects. Therefore, this review emphasizes the crucial role of vitamin D in regulating macrophage function and preventing the development of atherosclerosis.
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Affiliation(s)
- Dongxia Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Zhen Sun
- Department of Cardiology, Hebei International Joint Research Center for Structural Heart Disease, Hebei Key Laboratory of Cardiac Injury Repair Mechanism Study, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yajuan Yin
- Department of Cardiology, Hebei International Joint Research Center for Structural Heart Disease, Hebei Key Laboratory of Cardiac Injury Repair Mechanism Study, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Jingyi Xiang
- Department of Cardiology, Hebei International Joint Research Center for Structural Heart Disease, Hebei Key Laboratory of Cardiac Injury Repair Mechanism Study, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yuzhe Wei
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yuxia Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Le Wang
- Department of Cardiology, Hebei International Joint Research Center for Structural Heart Disease, Hebei Key Laboratory of Cardiac Injury Repair Mechanism Study, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Gang Liu
- Department of Cardiology, Hebei International Joint Research Center for Structural Heart Disease, Hebei Key Laboratory of Cardiac Injury Repair Mechanism Study, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, China
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Xiong J, Zhao C, Li J, Li Y. A systematic review and meta-analysis of the linkage between low vitamin D and the risk as well as the prognosis of stroke. Brain Behav 2024; 14:e3577. [PMID: 38873864 PMCID: PMC11177038 DOI: 10.1002/brb3.3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 05/05/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE The research intended to probe the connection between the risk of stroke and serum vitamin D levels. METHODS Three electronic databases (Cochrane Library, EMBASE, PubMed) were searched according to the subject terms from inception until July 29, 2022, and retrieved researches were screened on the basis of inclusion and exclusion criteria. Two investigators conducted the quality assessment and data extraction. Using Stata 16.0 software, a meta-analysis was conducted on the extracted data. FINDINGS In total, 27 studies with 45,302 participants were included. Among these studies, 20 focused on stroke risk, while 7 examined stroke prognosis. According to the meta-analysis findings, it was observed that a higher stroke risk is connected to reduced levels of serum vitamin D. This association was reflected in a combined relative risk (RR) of 1 .28 (95% confidence interval (CI): 1.15-1.42) and a worse prognosis after stroke (RR = 2.95, 95% CI: 1.90-4.60). Additional analysis indicated that no apparent relationship between a decrease in vitamin D and the probability of experiencing a hemorrhagic stroke was found. The RR found was 1.93 (95% CI: 0.95-3.95). On the other hand, it was observed that a reduction in serum vitamin D levels was linked to an elevated likelihood of developing an ischemic stroke. The RR identified was 1.72 (95% CI: 1.78-2.03). Moreover, a lower level of vitamin D in the bloodstream was associated with a more unfavorable prognosis for individuals who suffered from a stroke. The RR for this correlation was 2.95 (95% CI: 1.90-4.60). However, further research is required to confirm the above-mentioned findings. CONCLUSION In conclusion, lower concentration vitamin D was found to be related to an increased risk of stroke, which could mainly be reflected in ischemic stroke patients but not in patients with hemorrhagic stroke. A lower serum vitamin D level was correlative with the poor prognosis of stroke.
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Affiliation(s)
- Jianrong Xiong
- Department of Rehabilitation Medicine, Fourth Affiliated Hospital of Zhejiang University Medical College, Yiwu, Zhejiang, China
| | - Chenliang Zhao
- Intensive Care Medicine, Heyou Hospital, Foshan, Guangzhou, China
| | - Jinhui Li
- Department of Chinese Medicine & Rehabilitation Medicine, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang, China
| | - Yongxiang Li
- Department of Rehabilitation Medicine, Fourth Affiliated Hospital of Zhejiang University Medical College, Yiwu, Zhejiang, China
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Tripathi S, Nath M, Misra S, Kumar P. From A to E: Uniting vitamins against stroke risk-A systematic review and network meta-analysis. Eur J Clin Invest 2024; 54:e14165. [PMID: 38291560 DOI: 10.1111/eci.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/05/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND AIM Stroke represents a significant public health challenge, necessitating the exploration of preventive measures. This network meta-analysis aimed to assess the efficacy of different vitamin treatments compared to a placebo in preventing stroke. METHODS A systematic electronic search in databases including PubMed, EmBASE, Web of Science, clinicaltrials.gov, and Google Scholar until 31 May 2023 was conducted, to identify published studies investigating the association between vitamin intake and the risk of stroke. Pooled risk ratio (RR) with 95% confidence intervals (CIs) was calculated using a frequentist network meta-analysis. Furthermore, we ranked vitamins based on p-scores, facilitating a comparative assessment of their effectiveness in preventing stroke. RESULTS A total of 56 studies, including 17 randomized controlled trials (RCTs) and 39 cohort studies were analyzed. Direct estimates obtained from network meta-analysis, we found that vitamin A (RR: .81 [.72-.91]), vitamin B-complex (RR: .85 [.74-.97]), vitamin B6 (RR: 79 [.68-.92]), folate (RR: .86 [.75-.97]), vitamin C (RR: .77 [.70-.85]) and vitamin D (RR: .73 [.64-.83]) were significantly associated with a decreased stroke risk. However, no significant association was observed for vitamin B2, vitamin B12, and vitamin E. Subsequent to network meta-analysis, vitamins were ranked in decreasing order of their efficacy in stroke prevention based on p-score, with vitamin D (p-score = .91), vitamin C (p-score = .79), vitamin B6 (p-score = .70), vitamin A (p-score = .65), vitamin B-complex (p-score = .53), folate (p-score = .49), vitamin B2 (p-score = .39), vitamin E (p-score = .28), vitamin B12 (.13) and placebo (.10). CONCLUSION Our study has established noteworthy connections between vitamin A, vitamin B-complex, vitamin B6, folate, vitamin C, and vitamin D in the realm of stroke prevention. These findings add substantial weight to the accumulating evidence supporting the potential advantages of vitamin interventions in mitigating the risk of stroke. However, to solidify and validate these observations, additional research is imperative. Well-designed clinical trials or cohort studies are needed to further explore these associations and formulate clear guidelines for incorporating vitamin supplementation into effective stroke prevention strategies.
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Affiliation(s)
- Shashank Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manabesh Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Misra
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Pradeep Kumar
- Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India
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Celikbilek A, Koysuren A, Konar NM. Role of vitamin D in the association between pre-stroke sleep quality and poststroke depression and anxiety. Sleep Breath 2024; 28:841-848. [PMID: 37542680 DOI: 10.1007/s11325-023-02894-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Poor sleep quality, mood disorders, and vitamin D deficiency are common in stroke. We investigated the association between serum vitamin D levels and pre-stroke sleep quality and the occurrence of poststroke depression (PSD) and poststroke anxiety (PSA) in acute ischemic stroke (AIS). METHODS This prospective cross-sectional study included hospitalized patients with AIS and age- and sex-matched controls. Vitamin D levels were measured within 24 h of admission. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at admission. The severity of depression and anxiety symptoms was evaluated according to Beck Depression Inventory and Beck Anxiety Inventory scores, respectively, within 72 h after admission. RESULTS Comparing 214 AIS patients with 103 controls, patients had significantly higher scores of Beck Depression Inventory, Beck Anxiety Inventory, and PSQI and lower vitamin D levels (p < 0.001). Among AIS patients, Beck Depression Inventory (p = 0.004) and Beck Anxiety Inventory (p = 0.018) scores were significantly higher in bad sleepers (PSQI score ≥ 6) than in good sleepers (PSQI score ≤ 5). Correlation analysis revealed negative correlations between serum vitamin D levels and Beck Depression Inventory (r = - 0.234; p < 0.001), Beck Anxiety Inventory (r = - 0.135; p = 0.016), and PSQI (r = - 0.218; p < 0.001) scores. CONCLUSION Decreased serum vitamin D levels at admission are associated with a high risk for PSD and PSA in patients with poor pre-stroke sleep quality during the early stages of AIS.
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Affiliation(s)
- Asuman Celikbilek
- Department of Neurology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, 40100, Turkey.
| | - Aydan Koysuren
- Department of Neurology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, 40100, Turkey
| | - Naime Meric Konar
- Department of Biostatistics and Medical Informatics, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
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Habibi D, Teymoori F, Ebrahimi N, Fateh ST, Najd-Hassan-Bonab L, Saeidian AH, Soleymani Taloubaghi A, Asgarian S, Hosseinpanah F, Hakonarson H, Azizi F, Hedayati M, Daneshpour MS, Akbarzadeh M, Mansourian M. Causal effect of serum 25 hydroxyvitamin D concentration on cardioembolic stroke: Evidence from two-sample Mendelian randomization. Nutr Metab Cardiovasc Dis 2024; 34:1305-1313. [PMID: 38508993 DOI: 10.1016/j.numecd.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND AIMS The putative association between serum 25-hydroxyvitamin D concentration [25(OH)D] and the risk of cardioembolic stroke (CES) has been examined in observational studies, which indicate controversial findings. We performed Mendelian randomization (MR) analysis to determine the causal relationship of serum 25(OH)D with the risk of CES. METHODS AND RESULTS The summary statistics dataset on the genetic variants related to 25(OH)D was used from the published GWAS of European descent participants in the UK Biobank, including 417,580 subjects, yielding 143 independent loci in 112 1-Mb regions. GWAS summary data of CES was obtained from GIGASTROKE Consortium, which included European individuals (10,804 cases, 1,234,808 controls). Our results unveiled a causal relationship between 25(OH)D and CES using IVW [OR = 0.82, 95% CI: 0.67-0.98, p = 0.037]. Horizontal pleiotropy was not seen [MR-Egger intercept = 0.001; p = 0.792], suggesting an absence of horizontal pleiotropy. Cochrane's Q [Q = 78.71, p-value = 0.924], Rucker's Q [Q = 78.64, p-value = 0.913], and I2 = 0.0% (95% CI: 0.0%, 24.6%) statistic suggested no heterogeneity. This result remained consistent using different MR methods and sensitivity analyses, including Maximum likelihood [OR = 0.82, 95%CI: 0.67-0.98, p-value = 0.036], Constrained maximum likelihood [OR = 0.76, 95%CI: 0.64-0.90, p-value = 0.002], Debiased inverse-variance weighted [OR = 0.82, 95%CI: 0.68-0.99, p-value = 0.002], MR-PRESSO [OR = 0.82, 95%CI 0.77-0.87, p-value = 0.022], RAPS [OR = 0.82, 95%CI 0.67-0.98, p-value = 0.038], MR-Lasso [OR = 0.82, 95%CI 0.68-0.99, p-value = 0.037]. CONCLUSION Our MR analysis provides suggestive evidence that increased 25(OH)D levels may play a protective role in the development of cardioembolic stroke. Determining the role of 25(OH)D in stroke subtypes has important clinical and public health implications.
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Affiliation(s)
- Danial Habibi
- Department of Biostatistics and Epidemiology, School of Health, and Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Farshad Teymoori
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti, Tehran, Iran; Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Navid Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Leila Najd-Hassan-Bonab
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Amir Hossein Saeidian
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Abramson Research Building, Suite 1016I, 3615 Civic Center Boulevard, Philadelphia, PA, 19104-4318, USA.
| | - Alireza Soleymani Taloubaghi
- Data Science and AI Applications, Graduate School of Engineering Science and Technology, National Yunlin University of Science and Technology, Douliu, Taiwan.
| | - Sara Asgarian
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Abramson Research Building, Suite 1016I, 3615 Civic Center Boulevard, Philadelphia, PA, 19104-4318, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Sadat Daneshpour
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahdi Akbarzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Marjan Mansourian
- Epidemiology and Biostatistics Department, School of Health, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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8
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Cui P, Hou H, Song B, Xia Z, Xu Y. Vitamin D and ischemic stroke - Association, mechanisms, and therapeutics. Ageing Res Rev 2024; 96:102244. [PMID: 38395199 DOI: 10.1016/j.arr.2024.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Confronting the rising tide of ischemic stroke and its associated mortality and morbidity with ageing, prevention and acute management of ischemic stroke is of paramount importance. Mounting observational studies have established a non-linear association of vitamin D status with cardiovascular diseases, including ischemic stroke. Paradoxically, current clinical trials fail to demonstrate the cardiovascular benefits of vitamin D supplementation. We aim to update recent clinical and experimental findings on the role of vitamin D in the disease course of ischemic stroke, from its onset, progression, recovery, to recurrence, and the established and alternative possible pathophysiological mechanisms. This review justifies the necessities to address stroke etiological subtypes and focus on vitamin D-deficient subjects for investigating the potential of vitamin D supplementation as a preventive and therapeutic approach for ischemic stroke. Well-powered clinical trials are warranted to determine the efficacy, safety, timing, target individuals, optimal dosages, and target 25OHD concentrations of vitamin D supplementation in the prevention and treatment of ischemic stroke.
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Affiliation(s)
- Pan Cui
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China; Clinical Systems Biology Laboratories, Translation Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Haiman Hou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Zongping Xia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China; Clinical Systems Biology Laboratories, Translation Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China.
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China; Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China.
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Zhan Q, Kong F. Mechanisms associated with post-stroke depression and pharmacologic therapy. Front Neurol 2023; 14:1274709. [PMID: 38020612 PMCID: PMC10651767 DOI: 10.3389/fneur.2023.1274709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Stroke is one of the most common cerebrovascular diseases, which is the cause of long-term mental illness and physical disability, Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke, and its mechanisms are characterized by complexity, plurality, and diversity, which seriously affects the quality of survival and prognosis of patients. Studies have focused on and recognized neurotransmitter-based mechanisms and selective serotonin-reuptake inhibitors (SSRIs) can be used to treat PSD. Neuroinflammation, neuroendocrinology, neurotrophic factors, and the site of the stroke lesion may affect neurotransmitters. Thus the mechanisms of PSD have been increasingly studied. Pharmacological treatment mainly includes SSRIs, noradrenergic and specific serotonergic antidepressant (NaSSA), anti-inflammatory drugs, vitamin D, ect, which have been confirmed to have better efficacy by clinical studies. Currently, there is an increasing number of studies related to the mechanisms of PSD. However, the mechanisms and pharmacologic treatment of PSD is still unclear. In the future, in-depth research on the mechanisms and treatment of PSD is needed to provide a reference for the prevention and treatment of clinical PSD.
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Affiliation(s)
- Qingyang Zhan
- Institute of Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Fanyi Kong
- Neurosurgery, Affiliated First Hospital, Harbin Medical University, Harbin, China
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10
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Fleet JL, McIntyre A, Janzen S, Saikaley M, Qaqish M, Cianfarani R, Papaioannou A. A systematic review examining the effect of vitamin D supplementation on functional outcomes post-stroke. Clin Rehabil 2023; 37:1451-1466. [PMID: 37166229 PMCID: PMC10492437 DOI: 10.1177/02692155231174599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The objective of this systematic review was to explore the effect of vitamin D supplementation on functional outcomes (motor function, mobility, activities of daily living and stroke impairment) among individuals post-stroke (PROSPERO CRD42022296462). DATA SOURCES MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for all articles published up to March 5, 2023. METHODS Only interventional studies assessing vitamin D supplementation compared to placebo or usual care in adult stroke patients were selected. After duplicate removal, 2912 studies were screened by two independent reviewers. A total of 43 studies underwent full text review; 10 studies met inclusion criteria (8 randomized controlled trials and 2 non-randomized studies of intervention). Data were extracted by two independent reviewers using Covidence software. Motor function (Brunnstrom Recovery Stage, Berg Balance Score), mobility (Functional Ambulation Category), activities of daily living (Barthel Index, Functional Independence Measure) and stroke impairment (modified Rankin Scale, National Institutes for Health Stroke Severity, Scandinavian Stroke Severity) were the outcome measures of interest reported in the included studies. RESULTS In total, 691 patients were studied for which 11 of 13 outcome measures showed improvement with vitamin D supplementation. CONCLUSIONS The majority of studies showed a statistical improvement in motor function, mobility, and stroke impairment with vitamin D supplementation; however, the evidence did not support an improvement in activities of daily living with treatment. Despite this, there may not be clinical significance. Strong, methodologically sound, randomized controlled trials are required to verify these findings.
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Affiliation(s)
- Jamie L Fleet
- Department of Physical Medicine and Rehabilitation, Western University, London, Canada
- St. Joseph's Health Care London, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Amanda McIntyre
- Lawson Health Research Institute, London, Canada
- Arthur Labatt School of Nursing, Western University, London, Canada
| | | | | | - Michael Qaqish
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Robert Cianfarani
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Alexandra Papaioannou
- Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Medicine, Division of Geriatrics, McMaster University, Hamilton, Canada
- Department of Medicine, Division of Rheumatology, McMaster University, Hamilton, Canada
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11
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Haider F, Ghafoor H, Hassan OF, Farooqui K, Bel Khair AOM, Shoaib F. Vitamin D and Cardiovascular Diseases: An Update. Cureus 2023; 15:e49734. [PMID: 38161941 PMCID: PMC10757591 DOI: 10.7759/cureus.49734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Vitamin D is a vital nutrient that plays a significant part in several physiological processes within the human body, including calcium metabolism, bone health, immune function, and cell growth and differentiation. It is obtained mainly through exposure to sunlight but can be acquired from certain foods and supplements as well. Vitamin D deficiency (VDD) could be the risk factor for cardiovascular diseases (CVDs), such as heart disease and stroke. In blood vitamin D low levels have been linked with an enhanced risk of developing CVDs. However, it is unclear whether vitamin D levels are the leading cause or consequence of these conditions. While some studies highlight that taking vitamin D supplements could decrease the risk of CVD; however, more research is required to better understand the association between vitamin D and cardiovascular health. In this review, we aimed to summarize the currently available evidence supporting the association between vitamin D and CVDs and anesthesia considerations.
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Affiliation(s)
- Farrookh Haider
- Department of Internal Medicine, Section of Cardiology Al Khor Hospital, Hamad Medical Corporation, Al Khor, QAT
- Department of Internal Medicine, College of Medicine/Qatar University, Doha, QAT
| | - Hashsaam Ghafoor
- Department of Anesthesia, Al Khor Hospital, Hamad Medical Corporation, Al Khor, QAT
- Department of Anesthesiology, Qatar University, Doha, QAT
| | - Omar F Hassan
- Department of Internal Medicine, Section of Cardiology Al Khor Hospital, Hamad Medical Corporation, Al Khor, QAT
| | - Khalid Farooqui
- Department of Internal Medicine, Al Khor Hospital, Hamad Medical Corporation, Al Khor, QAT
| | | | - Faryal Shoaib
- Department of Internal Medicine, Shifa International Hospitals, Islamabad, PAK
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12
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Yang HE, Lee BW, Choi IJ, Oh JY, An EJ. Age-dependent effect of vitamin D supplementation on musculoskeletal health in chronic spinal cord injury patients: A pilot study. J Spinal Cord Med 2023:1-10. [PMID: 37851022 DOI: 10.1080/10790268.2023.2257850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To determine the effect of vitamin D supplementation on changes in body composition associated with musculoskeletal health status in patients with chronic SCI and vitamin D deficiency as a response to age. DESIGN Prospective drug-intervention study. SETTING Department of rehabilitation medicine, Veterans Health Service Medical Center. PARTICIPANTS Seventeen patients with vitamin D insufficiency/deficiency (<30 ng/mL) and chronic SCI were divided into two groups: groups A <65 years (n = 8) and B ≥65 years of age (n = 9). INTERVENTIONS Both groups received 800 IU/day cholecalciferol for 12 weeks. OUTCOME MEASURES We used blood samples to evaluate metabolites related to vitamin D, testosterone (T), lipid profiles, and sex hormone-binding globulin (SHBG). Bioelectrical impedance analysis (BIA) was used to evaluate body composition. RESULTS Group A had significantly better baseline clinical characteristics for all BIA measurements. SHGB was significantly higher in Group B (P = 0.003) and albumin was significantly higher in Group A (P = 0.000). When comparing pre- to post-treatment, Group A showed a significant improvement in T (P = 0.042), total cholesterol (P = 0.035), and triglyceride (P = 0.025) levels, whereas Group B significantly increased vitamin D (P = 0.038) and protein mass (PM) (P = 0.034) levels. CONCLUSION This study suggested that addressing vitamin D deficiency in patients with SCI had different effects in young and older adults, with both groups showing positive changes in body composition. Particularly, the increase in PM on BIA measurements in elderly patients at high risk of sarcopenia was encouraging.
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Affiliation(s)
- Hea-Eun Yang
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Byeong Wook Lee
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - I Jun Choi
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Ji Yeon Oh
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Eui Jin An
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, South Korea
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13
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Kamal K, Tewari J, Bharti V, Sharma D, Atam I, Atam V, Rana A, Roy S. Serum Vitamin D Level as a Risk Factor and Prognostic Marker for Acute Ischemic Stroke: A Case-Control Study at a Tertiary Care Centre in Northern India. Cureus 2023; 15:e46117. [PMID: 37900424 PMCID: PMC10612136 DOI: 10.7759/cureus.46117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Stroke is a predominant cause of death worldwide. Major risk factors for stroke in any age group are diabetes, hypertension, heart disease, smoking, and long-term alcohol abuse. It is of utmost importance to identify the risk factors for stroke to prevent recurrence. Vitamin D deficiency is identified as a risk factor for stroke. Therefore, we attempted to look for a correlation between vitamin D levels and acute ischemic stroke. Methods This observational case-control study was conducted with 150 patients (75 cases and 75 controls). On the day of admission, the National Institutes of Health Stroke Scale (NIHSS) score was calculated, and vitamin D levels were measured for each patient. The functional outcome was determined by the modified Rankin scale (mRS). Results The most common risk factors identified in this study were hypertension (61.3%), diabetes mellitus (41.3%), and smoking (37.3%). Out of 75 patients enrolled in the study, 49.4% had significant vitamin D deficiency, and 30.6% had insufficient vitamin D levels. Our study showed a significant correlation between vitamin D sufficiency in the body and the incidence of stroke (x2=3.888 and p=0.048). A significant correlation (p=0.03) was found between the NIHSS score and vitamin D levels in patients with acute ischemic stroke. Conclusion In this observational case-control study, we concluded that the increasing severity of vitamin D deficiency was associated with more deaths and poor outcomes.
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Affiliation(s)
- Kislaya Kamal
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Jay Tewari
- Medicine, King George's Medical University, Lucknow, IND
| | - Vipin Bharti
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Deepak Sharma
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Isha Atam
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Virendra Atam
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Anadika Rana
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Shubhajeet Roy
- Medicine, King George's Medical University, Lucknow, IND
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14
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Chen TB, Chang CM, Yang CC, Tsai IJ, Wei CY, Yang HW, Yang CP. Neuroimmunological Effect of Vitamin D on Neuropsychiatric Long COVID Syndrome: A Review. Nutrients 2023; 15:3802. [PMID: 37686834 PMCID: PMC10490318 DOI: 10.3390/nu15173802] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 2019 (COVID-19). COVID-19 is now recognized as a multiorgan disease with a broad spectrum of manifestations. A substantial proportion of individuals who have recovered from COVID-19 are experiencing persistent, prolonged, and often incapacitating sequelae, collectively referred to as long COVID. To date, definitive diagnostic criteria for long COVID diagnosis remain elusive. An emerging public health threat is neuropsychiatric long COVID, encompassing a broad range of manifestations, such as sleep disturbance, anxiety, depression, brain fog, and fatigue. Although the precise mechanisms underlying the neuropsychiatric complications of long COVID are presently not fully elucidated, neural cytolytic effects, neuroinflammation, cerebral microvascular compromise, breakdown of the blood-brain barrier (BBB), thrombosis, hypoxia, neurotransmitter dysregulation, and provoked neurodegeneration are pathophysiologically linked to long-term neuropsychiatric consequences, in addition to systemic hyperinflammation and maladaptation of the renin-angiotensin-aldosterone system. Vitamin D, a fat-soluble secosteroid, is a potent immunomodulatory hormone with potential beneficial effects on anti-inflammatory responses, neuroprotection, monoamine neurotransmission, BBB integrity, vasculometabolic functions, gut microbiota, and telomere stability in different phases of SARS-CoV-2 infection, acting through both genomic and nongenomic pathways. Here, we provide an up-to-date review of the potential mechanisms and pathophysiology of neuropsychiatric long COVID syndrome and the plausible neurological contributions of vitamin D in mitigating the effects of long COVID.
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Affiliation(s)
- Ting-Bin Chen
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Ching-Mao Chang
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Cheng-Chia Yang
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan;
| | - I-Ju Tsai
- Department of Medical Research, Kuang Tien General Hospital, Taichung 433, Taiwan;
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua 50544, Taiwan
| | - Hao-Wen Yang
- Department of Family Medicine, Kuang Tien General Hospital, Taichung 433, Taiwan
| | - Chun-Pai Yang
- Department of Medical Research, Kuang Tien General Hospital, Taichung 433, Taiwan;
- Department of Neurology, Kuang Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, HungKuang University, Taichung 433, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
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15
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Li J, Xia K, Wang Z, Liu Y, Tong Y, Wang Y, Zhou Y, Zhang L, Tang L, Fan D, Yang Q. Essential nutrients and cerebral small vessel diseases: a two-sample Mendelian randomization study. Front Nutr 2023; 10:1172587. [PMID: 37426181 PMCID: PMC10325681 DOI: 10.3389/fnut.2023.1172587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background Previous studies have suggested a potential association between nutrients and cerebral small vessel disease (CSVD), but this association has not been fully addressed. Object We intended to clarify the causal associations between four categories of essential nutrients (amino acids, polyunsaturated fatty acids, minerals and vitamins) and two acute manifestations of CSVD (intracerebral hemorrhage and small vessel stroke) using two-sample Mendelian randomization (MR) analysis. Method We obtained European-based large-scale genome-wide association studies (GWASs) related to CSVD (6,255 cases and 233,058 controls) and nutrient concentrations. Causality evaluation mainly included the results of the inverse variance-weighted (IVW) method. The simple median method, the weighted median method and the MR-Egger method were adopted for sensitivity analyses. Results For ICH or SVS, increased levels of phenylalanine (OR = 1.188, p < 0.001) and dihomo-gamma-linolenic acid (DGLA) (OR = 1.153, p = 0.001) showed risk effects, while docosapentaenoic acid (DPA) (OR = 0.501, p < 0.001), zinc (OR = 0.919, p < 0.001), and arachidonic acid (OR = 0.966, p = 0.007) showed protective effects. For lobar hemorrhage or SVS, AA (OR = 0.978, p < 0.001), zinc (OR = 0.918, p < 0.001), and retinol (OR = 0.753, p < 0.001) showed risk effects; DPA (OR = 0.682, p = 0.022), gamma-linolenic acid (OR = 0.120, p = 0.033) and 25(OH)D (OR = 0.874, p = 0.040) showed protective effects. For nonlobar hemorrhage or SVS, DGLA (OR = 1.088, p < 0.001) and phenylalanine (OR = 1.175, p = 0.001) showed risk effects. Conclusion Our study analyzed the effect of nutrients on CSVD risk from a genetic perspective, with implications for CSVD prevention through nutrient supplementation.
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Affiliation(s)
- Jiayi Li
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Kailin Xia
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Zhengrui Wang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Yanru Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Yicheng Tong
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Yuwei Wang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Yumou Zhou
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Linjing Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
| | - Qiong Yang
- Department of Neurology, Peking University Third Hospital, Beijing, China
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16
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Della Nera G, Sabatino L, Gaggini M, Gorini F, Vassalle C. Vitamin D Determinants, Status, and Antioxidant/Anti-inflammatory-Related Effects in Cardiovascular Risk and Disease: Not the Last Word in the Controversy. Antioxidants (Basel) 2023; 12:antiox12040948. [PMID: 37107323 PMCID: PMC10135791 DOI: 10.3390/antiox12040948] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Beyond its key role in calcium homeostasis, vitamin D has been found to significantly affect the cardiovascular (CV) system. In fact, low vitamin D levels have been associated with increased CV risk, as well as increased CV morbidity and mortality. The majority of effects of this molecule are related directly or indirectly to its antioxidative and anti-inflammatory properties. Generally, vitamin D insufficiency is considered for 25-hydroxyvitamin D (25(OH)D) levels between 21-29 ng/mL (corresponding to 52.5-72.5 nmol/L), deficiency as 25(OH)D levels less than 20 ng/mL (<50 nmol/L), and extreme deficiency as 25(OH)D less than 10 ng/mL (<25 nmol/L). However, the definition of an optimal vitamin D status, as defined by 25(OH)D, remains controversial for many extra-bone conditions, including CV disease. In this review, confounding factors affecting the 25(OH)D measurement and status will be discussed. In particular, available evidence on the mechanism and role of vitamin D in relation to CV risk and disease through its antioxidant effect will be reported, also facing the aspect regarding the debate on the minimum blood 25(OH)D level required to ensure optimal CV health.
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17
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Xie Y, Acosta JN, Ye Y, Demarais ZS, Conlon CJ, Chen M, Zhao H, Falcone GJ. Whole-Exome Sequencing Analyses Support a Role of Vitamin D Metabolism in Ischemic Stroke. Stroke 2023; 54:800-809. [PMID: 36762557 PMCID: PMC10467223 DOI: 10.1161/strokeaha.122.040883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/22/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Ischemic stroke (IS) is a highly heritable trait, and genome-wide association studies have identified several commonly occurring susceptibility risk loci for this condition. However, there are limited data on the contribution of rare genetic variation to IS. METHODS We conducted an exome-wide study using whole-exome sequencing data from 152 058 UK Biobank participants, including 1777 IS cases. We performed single-variant analyses for rare variants and gene-based analyses for loss-of-function and deleterious missense rare variants. We validated these results through (1) gene-based testing using summary statistics from MEGASTROKE-a genome-wide association study of IS that included 67 162 IS cases and 454 450 controls, (2) gene-based testing using individual-level data from 1706 IS survivors, including 142 recurrent IS cases, enrolled in the VISP trial (Vitamin Intervention for Stroke Prevention); and (3) gene-based testing against neuroimaging phenotypes related to cerebrovascular disease using summary-level data from 42 310 UK Biobank participants with available magnetic resonance imaging data. RESULTS In single-variant association analyses, none of the evaluated variants were associated with IS at genome-wide significance levels (P<5×10-8). In the gene-based analysis focused on loss-of-function and deleterious missense variants, rare genetic variation at CYP2R1 was significantly associated with IS risk (P=2.6×10-6), exceeding the Bonferroni-corrected threshold for 16 074 tests (P<3.1×10-6). Validations analyses indicated that CYP2R1 was associated with IS risk in MEGASTROKE (gene-based test, P=0.003), with IS recurrence in the VISP trial (gene-based test, P=0.001) and with neuroimaging traits (white matter hyperintensity, mean diffusivity, and fractional anisotropy) in the UK Biobank neuroimaging study (all gene-based tests, P<0.05). CONCLUSIONS Because CYP2R1 plays an important role in vitamin D metabolism and existing observational evidence suggests an association between vitamin D levels and cerebrovascular disease, our results support a role of this pathway in the occurrence of IS.
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Affiliation(s)
- Yuhan Xie
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Julián N. Acosta
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Yixuan Ye
- Program of Computational Biology and Bioinformatics, Yale School of Medicine, New Haven, CT, USA
| | - Zachariah S. Demarais
- Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Carolyn J. Conlon
- Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Ming Chen
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Program of Computational Biology and Bioinformatics, Yale School of Medicine, New Haven, CT, USA
| | - Guido J. Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
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18
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Anagnostis P, Livadas S, Goulis DG, Rees M, Lambrinoudaki I. Vitamin D, Menopausal Health and COVID-19: Critical Appraisal of Current Data. J Clin Med 2023; 12:jcm12030916. [PMID: 36769563 PMCID: PMC9917790 DOI: 10.3390/jcm12030916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Inconsistency exists across studies conducted in postmenopausal women regarding the effect of vitamin D deficiency (VDD) and supplementation on several aspects of menopausal health, such as fractures, vasomotor symptomatology, cardiovascular disease (CVD), cancer and infections, including coronavirus disease 2019 (COVID-19). The aim of this review is to critically summarize the evidence provided by observational studies and randomized controlled trials (RCTs) of vitamin D supplementation in postmenopausal women with VDD. Observational studies have found that VDD is associated with an increased risk of falls and fractures after the menopause. VDD also has a negative effect on menopausal symptomatology. VDD, especially its severe form, is associated with an increased risk of CVD risk factors and CVD events. VDD is associated with increased risk and mortality from several cancer types and risk of infections. The evidence from RCTs regarding the effect of vitamin D supplementation on falls, fractures, menopausal symptoms, cardiovascular disease, cancer and infections is not robust. Thus, skeletal health may benefit only when vitamin D is co-administered with calcium, especially in those ≥70 years old and with severe VDD. There is no evidence of a favorable effect on menopausal symptoms or risk of CVD or cancer, except for a modest reduction in cancer-related mortality. Inconsistency still exists regarding its effect on infection risk, disease severity and mortality due to COVID-19.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 564 29 Thesssaloniki, Greece
- Correspondence: ; Tel.: +30-2310-257-150; Fax: +30-2310-281-179
| | | | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 564 29 Thesssaloniki, Greece
| | - Margaret Rees
- Women’s Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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19
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25-Hydroxy-Vitamin D and Risk of Recurrent Stroke: A Dose Response Meta-Analysis. Nutrients 2023; 15:nu15030512. [PMID: 36771220 PMCID: PMC9921019 DOI: 10.3390/nu15030512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
Stroke recurrence significantly improves the prognosis quoad vitam et valetudinem of patients with a first ischemic or haemorrhagic stroke. Other than in bone and skeletal metabolism, vitamin D is involved in the pathogenesis of cardiovascular disorders. This meta-analysis was performed to evaluate the relationship between 25OH-vitamin D [25(OH)D] levels at the first stroke and the stroke recurrence. To 31 July 2022, four prospective studies were identified. The potential non-linear relationship was evaluated by modelling 25(OH)D, using restricted cubic splines of 25(OH)D distribution. The pooled estimated risk (and 95% CI) of the recurrence of stroke, comparing the highest and the lowest levels, was assessed using a random-effect model. A non-linear association was found by dose-response analysis. This study found that 25(OH)D levels at the first stroke ≥9.3 ng/mL were associated with a lower risk of stroke recurrence, compared with 25(OH)D levels ≤8.5 ng/mL. In the pooled analysis, higher 25(OH)D levels at the first stroke significantly reduce the risk of stroke recurrence, with a significant heterogeneity among studies. In conclusion, 25(OH)D levels ≤8.5 ng/mL at the first stroke are significantly associated with a higher risk of recurrent stroke.
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20
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Hung KC, Wu JY, Illias AM, Chiu CC, Chang YJ, Liao SW, Wang KF, Chen IW, Sun CK. Association of a low vitamin D status with risk of post-stroke depression: A meta-analysis and systematic review. Front Nutr 2023; 10:1142035. [PMID: 36875853 PMCID: PMC9983120 DOI: 10.3389/fnut.2023.1142035] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Background Although post-stroke depression (PSD) affects one-third of patients following an acute stroke, pooled evidence addressing the correlation between a low vitamin D status and the risk of PSD remains inconclusive. Methods Comprehensive database search of Medline, EMBASE, Cochrane library, and Google Scholar was performed from inception to December 2022. The primary outcome was the association of PSD risk with a low vitamin D status, while the secondary outcomes included the relationship between PSD and other risk factors. Results Analysis of seven observational studies published between 2014 and 2022 with 1,580 patients showed pooled incidences of vitamin D deficiency (defined as 25[OH] D levels < 50 nmol/L) and PSD of 60.1 and 26.1%, respectively. Patients with PSD had a lower circulating vitamin D concentration compared to those without [mean difference (MD) =-13.94 nmol/L, 95% CI: -21.83 to -6.05, p = 0.0005, I 2 = 91%, six studies, 1,414 patients]. Meta-analysis also demonstrated a correlation between a low vitamin D level and an increased PSD risk [odd ratio (OR) = 3.25, 95% CI: 1.57-6.69, p = 0.001, I 2 = 78.7%, 1,108 patients], the heterogeneity of which was found to be associated with the incidence of vitamin D deficiency but not female proportion on meta-regression. Besides, female gender (OR = 1.78, 95% CI: 1.3-2.44, p = 0.003, I 2 = 31%, five studies, 1,220 patients), hyperlipidemia (OR = 1.55, 95% CI: 1.01-2.36, p = 0.04, I 2 = 0%, four studies, 976 patients), and high National Institutes of Health Stroke Scale (NIHSS) scores (MD = 1.45, 95% CI: 0.58-2.32, p = 0.001, I 2 = 82%, five studies, 1,220 patients) were potential risk factors for PSD. For the primary outcome, the certainty of evidence was very low. Regarding secondary outcomes, the certainty of evidence was low for BMI, female gender, hypertension, diabetes, and stroke history, and very low for age, level of education, hyperlipidemia, cardiovascular disease, and NIHSS scores. Conclusion The results suggested an association of a low circulating vitamin D level with an increased risk of PSD. Besides, female gender, hyperlipidemia, high NIHSS score were related to an increased risk or occurrence of PSD. The current study may imply the necessity of routine circulating vitamin D screening in this population. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022381580.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.,School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Amina M Illias
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung City, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan.,Department of Medical Education and Research, E-Da Cancer Hospital, Kaohsiung City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Shu-Wei Liao
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuei-Fen Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Cheuk-Kwan Sun
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan.,Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
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21
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Safari A, Fadakar N, Borhani-Haghighi A. The Association Between Inflammatory Biomarkers and Vitamin D Level With the Evolution and Severity of Stroke. Basic Clin Neurosci 2022; 13:807-814. [PMID: 37323962 PMCID: PMC10262286 DOI: 10.32598/bcn.2021.1971.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/14/2019] [Accepted: 02/10/2020] [Indexed: 11/02/2023] Open
Abstract
Introduction Vitamin D deficiency has been linked to the evolution of ischemic stroke, but the data regarding the association between stroke severity and vitamin D level is scarce. Methods Patients with first-ever ischemic stroke in the middle cerebral artery territory, within seven days after the stroke, were recruited. The control group included age- and gender-matched individuals. We compared 25-OH vitamin D (vitamin D), high sensitive C-reactive protein (hsCRP), serum amyloid A (SAA), and osteopontin levels between stroke patients and the control group. The association between stroke severity according to the National Institutes of Health Stroke Scale (NIHSS) and the Alberta stroke program early CT score (ASPECTS) and levels of vitamin D and inflammatory biomarkers were also studied. Results There was an association between hypertension (P=0.035), diabetes mellitus (P=0.043), smoking (P=0.016), history of ischemic heart disease (P=0.002), higher SAA (P<0.001), higher hsCRP (P<0.001), and lower vitamin D levels (P=0.002) and stroke evolution in a case-control study. Meanwhile, in stroke patients, its severity was associated with higher SAA (P=0.04) and hsCRP (P=0.001), and lower vitamin D levels (P=0.043) according to clinical scale (higher admission NIHSS). According to the ASPECT score, higher SAA (P=0.017) and hsCRP (P=0.007), but not lower vitamin D levels, were associated with more infarct areas (P=0.149). Conclusion Vitamin D may play a role in both the evolution and severity of stroke.
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Affiliation(s)
- Anahid Safari
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Fadakar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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The Association between Serum Vitamin D Concentration and New Inflammatory Biomarkers-Systemic Inflammatory Index (SII) and Systemic Inflammatory Response (SIRI)-In Patients with Ischemic Heart Disease. Nutrients 2022; 14:nu14194212. [PMID: 36235864 PMCID: PMC9570511 DOI: 10.3390/nu14194212] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 11/17/2022] Open
Abstract
The incidence of ischemic heart disease (IHD) increases every year. This cardiovascular disease has an inflammatory factor in its etiology due to different immune cells that influence atherogenesis. New inflammatory biomarkers—the Systemic Inflammatory Index (SII) and the Systemic Inflammatory Response (SIRI)—attempt to describe the pro- and anti-inflammatory balance and quantify the complex impact of the immune system on atherosclerosis, while vitamin D has a multidirectional impact on the human body, including the cardiovascular and immune systems. Hence, the objective of this research was to analyze the association between SII and SIRI and serum vitamin D concentrations in patients with IHD. A significant correlation was observed between SIRI and 25(OH)D in the whole group and between both biomarkers (SII and SIRI) and 25(OH)D in the group of patients with ACS but not in the group of patients with stable IHD. The role of vitamin D in IHD complications and its association with new inflammatory biomarkers requires further well-designed, large-scale research.
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23
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Fu J, Sun J, Zhang C. Vitamin D supplementation and risk of stroke: A meta-analysis of randomized controlled trials. Front Neurol 2022; 13:970111. [PMID: 36062009 PMCID: PMC9434369 DOI: 10.3389/fneur.2022.970111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrevious observational studies have supported the hypothesis that vitamin D supplementation protects against stroke. However, several current intervention studies contradict this observation. Therefore, we conducted a meta-analysis to investigate further the association between vitamin D supplementation and the risk of stroke.MethodsThis meta-analysis was conducted in accordance with the PRISMA statement and included all the randomized controlled trials (RCTs) that analyzed the relationship between vitamin D supplementation and the risk of stroke. A literature search strategy was established, and the following Medical Search Terms (MeSH) were used: “vitamin D,” “Calcitriol,” “Calcifediol,” “Cholecalciferol,” “25-Hydroxyvitamin D 2,” “ergocalciferols,” “stroke,” and stroke-derived terms. We searched for articles published before January 2022 in several databases, namely, PubMed, Web of Science, EMBASE, and The Cochrane Library. We also reviewed references included in relevant published meta-analyses and searched the http://www.ClinicalTrials.gov website for additional RCTs. The Q test and I2 were utilized to assess the degree of heterogeneity among the studies. Review Manager 5.3 and STATA16.0 software programs were used to assess the literature quality and perform statistical analyses.ResultsIn total, twenty-four RCTs (86,202 participants) were included. There was no statistical heterogeneity among the RCTs (I2 = 0.0%, P = 0.94) included in this meta-analysis. We determined that vitamin D supplementation was not associated with a reduced risk of stroke compared with the placebo (RR = 1.02, 95% CI: 0.93–1.13, P = 0.65). In total, 10 studies only included women, and 14 studies included women and men among the 24 RCTs. Therefore, we performed a subgroup analysis based on sex. After the subgroup analysis, the effect remained statistically insignificant (mixed-sex group: RR = 1.06, 95% CI: 0.93–1.22, P = 0.37, women group: RR = 0.98, 95% CI: 0.86–1.13, P = 0.80). The results were generally comparable, based on age, body mass index (BMI), follow-up period, baseline 25-hydroxyvitamin D (25(OH)D) levels, the designated endpoint, latitude, vitamin D dosage, type of vitamin D administered, and an absence or presence of concurrent calcium supplementation (P > 0.05).ConclusionOur study revealed that additional vitamin D supplementation did not reduce the risk of stroke. Therefore, additional RCTs of similar design should not be encouraged to assess any association between vitamin D supplementation and reduced stroke risk.
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Affiliation(s)
- Jia Fu
- Department of Neurology, Chifeng Municipal Hospital, Chifeng, China
- *Correspondence: Jia Fu
| | - Junfang Sun
- The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Chao Zhang
- Department of Geriatrics, Chifeng Municipal Hospital, Chifeng, China
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24
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Wei S, Yuan X, Li D, Fan F, Guo X, Xu Y, Guan S. Vitamin D level is associated with rupture of intracranial aneurysm in patients with subarachnoid hemorrhage. Front Neurol 2022; 13:890950. [PMID: 36034296 PMCID: PMC9403761 DOI: 10.3389/fneur.2022.890950] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIncreasing evidence supports the relationship between vitamin D levels and stroke. However, there are few studies on the association between vitamin D levels and subarachnoid hemorrhage (SAH), especially in patients with aneurysmal SAH. The present study investigated the association between vitamin D level and rupture of intracranial aneurysm in a cohort of patients with SAH.MethodsThe data of patients diagnosed with SAH at our hospital between September 2019 and December 2020 were retrospectively reviewed. Patients' information was collected, and serum vitamin D levels were measured. Computed tomography was performed to confirm SAH diagnosis, and digital subtraction angiography was performed to determine whether SAH was caused by rupture of an intracranial aneurysm. Multivariate logistic regression analyses were performed to investigate the association between vitamin D level and aneurysmal SAH.ResultsOverall, 193 patients with SAH were evaluated; 160 with aneurysmal SAH (age 55.86 ± 12.30 years, 63.15% female) and 33 with non-aneurysmal SAH (age 56.21 ± 9.92 years, 45.45% female). Univariate analysis showed that the vitamin D level in aneurysmal SAH was lower than that in non-aneurysmal SAH (16.95 ± 8.69 vs. 22.74 ± 9.12 ng/ml, p = 0.001). In addition, there were more patients with hypertension in aneurysmal SAH group than in non-aneurysmal SAH group (53.75 vs. 24.24%, p = 0.002). Notably, there was still a strong correlation between vitamin D level and aneurysmal SAH after adjusting for confounders in the multivariate model [OR (odds ratio), 0.935; 95% CI (confidence interval), 0.890–0.983; p = 0.008].ConclusionVitamin D level is associated with rupture of intracranial aneurysm in patients with SAH. Patients with aneurysmal SAH have lower vitamin D levels than those with non-aneurysmal SAH.
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Affiliation(s)
- Sen Wei
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Yuan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongdong Li
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Fan
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinbin Guo
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Xu
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yuming Xu
| | - Sheng Guan
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Sheng Guan
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25
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Ding C, Bi C, Lin T, Liu L, Song Y, Wang B, Wang P, Fang C, Ma H, Huang X, Xu X, Zhang H, Hu L, Huo Y, Wang X, Bao H, Cheng X. Association between serum calcium levels and first stroke: A community-based nested case-control study. Front Neurol 2022; 13:938794. [PMID: 35989922 PMCID: PMC9388910 DOI: 10.3389/fneur.2022.938794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Evidence from epidemiologic studies has been limited and inconsistent regarding the role of serum calcium in stroke incidence risk. We aimed to evaluate the association between serum albumin-corrected calcium and the risk of the first stroke in the Chinese community-dwelling population. Methods The study sample population was drawn from the “H-type Hypertension and Stroke Prevention and Control Project.” Using a nested case-control study, a total of 1,255 first-stroke cases and 1,255 controls matched for age, sex, and village were included in the final data analysis. We measured the serum calcium by inductively coupled plasma mass spectrometry and assessed the associations between serum albumin-corrected calcium and first stroke using conditional logistic regression. Results The overall mean (SD) serum albumin-corrected calcium was 8.9 (0.6) mg/dl. Compared with the middle tertile (8.7–9.1 mg/dl), the multivariate-adjusted odds ratios (95% CIs) of first total stroke associated with the lowest tertile and the highest tertile of serum albumin-corrected calcium were 1.37 (1.10, 1.70) and 1.30 (1.04, 1.62), respectively. Similar trends were observed for the first ischemic stroke. Consistently, restricted cubic spline showed a U-shaped association between serum albumin-corrected calcium and risk of total stroke and ischemic stroke. However, serum albumin-corrected calcium had no significant effect on first hemorrhagic stroke. No significant effect modification was observed in the subgroup analysis. Conclusions Our results suggested a U-shaped association between serum calcium and first stroke; both low and high serum calcium levels were associated with an increased risk of the first stroke in the Chinese population.
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Affiliation(s)
- Congcong Ding
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chonglei Bi
- People's Hospital of Rongcheng, Rongcheng, China
| | - Tengfei Lin
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lishun Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yun Song
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Binyan Wang
- Institute of Biomedicine, Anhui Medical University, Hefei, China
- Department of Research, Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Ping Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | | | - Hai Ma
- Health and Family Planning Commission, Rongcheng, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiping Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Hao Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lihua Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Huihui Bao
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Xiaoshu Cheng
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26
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Szejko N, Acosta JN, Both CP, Leasure A, Matouk C, Sansing L, Gill TM, Hongyu Z, Sheth K, Falcone GJ. Genetically-Proxied Levels of Vitamin D and Risk of Intracerebral Hemorrhage. J Am Heart Assoc 2022; 11:e024141. [PMID: 35730641 PMCID: PMC9333362 DOI: 10.1161/jaha.121.024141] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The evidence linking vitamin D (VitD) levels and spontaneous intracerebral hemorrhage (ICH) remains inconclusive. We tested the hypothesis that lower genetically determined VitD levels are associated with higher risk of ICH. Methods and Results We conducted a 2 sample Mendelian Randomization (MR) study using publicly available summary statistics from published genome-wide association studies of VitD levels (417 580 study participants) and ICH (1545 ICH cases and 1481 matched controls). We used the inverse-variance weighted approach to generate causal estimates and the MR Pleiotropy Residual Sum and Outlier and MR-Egger approaches to assess for horizontal pleiotropy. To account for known differences in their underlying mechanism, we implemented stratified analysis based on the location of the hemorrhage within the brain (lobar or nonlobar). Our primary analysis indicated that each SD decrease in genetically instrumented VitD levels was associated with a 60% increased risk of ICH (odds ratio [OR], 1.60; [95% CI, 1.05-2.43]; P=0.029). We found no evidence of horizontal pleiotropy (MR-Egger intercept and MR Pleiotropy Residual Sum and Outlier global test with P>0.05). Stratified analyses indicated that the association was stronger for nonlobar ICH (OR, 1.87; [95% CI, 1.18-2.97]; P=0.007) compared with lobar ICH (OR, 1.43; [95% CI, 0.86-2.38]; P=0.17). Conclusions Lower levels of genetically proxied VitD levels are associated with higher ICH risk. These results provide evidence for a causal role of VitD metabolism in ICH.
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Affiliation(s)
- Natalia Szejko
- Department of NeurologyYale School of MedicineNew HavenCT
- Department of BioethicsMedical University of WarsawPoland
- Department of NeurologyMedical University of WarsawPoland
| | | | | | - Audrey Leasure
- Department of NeurologyYale School of MedicineNew HavenCT
| | - Charles Matouk
- Department of NeurosurgeryYale School of MedicineNew HavenCT
| | - Lauren Sansing
- Department of NeurologyYale School of MedicineNew HavenCT
| | - Thomas M. Gill
- Department of Internal Medicine, Geriatric MedicineYale School of MedicineNew HavenCT
| | - Zhao Hongyu
- Department of BiostatisticsYale School of Public HealthNew HavenCT
| | - Kevin Sheth
- Department of NeurologyYale School of MedicineNew HavenCT
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The Role of Vitamin D in Stroke Prevention and the Effects of Its Supplementation for Post-Stroke Rehabilitation: A Narrative Review. Nutrients 2022; 14:nu14132761. [PMID: 35807941 PMCID: PMC9268813 DOI: 10.3390/nu14132761] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 01/27/2023] Open
Abstract
Hypovitaminosis D is a serious public health problem, representing an independent factor in mortality among the general population. Vitamin D deficiency may affect up to one billion people worldwide. Recently, the potential association between vitamin D levels and stroke has gained increasing attention. Many studies suggest that maintaining normal serum vitamin D levels is associated with improvement of the cardiovascular system and a reduction in stroke risk. As a neurosteroid, vitamin D influences brain development and function and immunomodulation and affects brain neuroplasticity. It supports many processes that maintain homeostasis in the body. As stroke is the second most common cause of death worldwide, more studies are needed to confirm the positive effects of vitamin D supplementation, its dosage at different stages of the disease, method of determination, and effect on stroke onset and recovery. Many studies on stroke survivors indicate that serum vitamin D levels only offer insignificant benefits and are not beneficial to recovery. This review article aims to highlight recent publications that have examined the potential of vitamin D supplementation to improve rehabilitation outcomes in stroke survivors. Particular attention has been paid to stroke prevention.
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Prediction Model between Serum Vitamin D and Neurological Deficit in Cerebral Infarction Patients Based on Machine Learning. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2914484. [PMID: 35799673 PMCID: PMC9256304 DOI: 10.1155/2022/2914484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022]
Abstract
Objective Vitamin D is associated with neurological deficits in patients with cerebral infarction. This study uses machine learning to evaluate the prediction model's efficacy of the correlation between vitamin D and neurological deficit in patients with cerebral infarction. Methods A total of 200 patients with cerebral infarction admitted to the Department of Neurology of our hospital from July 2018 to June 2019 were selected. The patients were randomly divided into a training set (n = 140) and a test set (n = 60) in a 7 : 3 ratio. The prediction model is constructed from the training set's data, and the model's prediction effect was evaluated by test set data. The area under the receiver operator characteristic curve was used to assess the prediction efficiency of models. Results In the training set, the area under the curve (AUC) of the logistic regression model and XGBoost algorithm model was 0.727 (95% CI: 0.601~0.854) and 0.818 (95% CI: 0.734~0.934), respectively. While in the test set, the AUC of the logistic regression model and XGBoost algorithm model was 0.761 (95% CI: 0.640~0.882) and 0.786 (95% CI: 0.670~0.902), respectively. Conclusion The prediction model of the correlation between vitamin D and neurological deficit in patients with cerebral infarction based on machine learning has a good prediction efficiency.
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Li G, Li L, Adachi JD, Wang R, Ye Z, Liu X, Thabane L, Lip GYH. Relationship between Serum 25-Hydroxyvitamin D Level and Risk of Recurrent Stroke. Nutrients 2022; 14:1908. [PMID: 35565874 PMCID: PMC9099592 DOI: 10.3390/nu14091908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022] Open
Abstract
Evidence for the association between vitamin D and risk of recurrent stroke remains sparse and limited. We aimed to assess the relationship between serum circulating 25-hydroxyvitamin D (25(OH)D) level and risk of recurrent stroke in patients with a stroke history, and to identify the optimal 25(OH)D level in relation to lowest recurrent stroke risk. Data from the nationwide prospective United Kingdom Biobank were used for analyses. Primary outcome was time to first stroke recurrence requiring a hospital visit during follow-up. We used Cox proportional hazards regression model with restricted cubic splines to explore 25(OH)D level in relation to recurrent stroke. The dose-response relationship between 25(OH)D and recurrent stroke risk was also estimated, taking the level of 10 nmol/L as reference. A total of 6824 participants (mean age: 60.6 years, 40.8% females) with a baseline stroke were included for analyses. There were 388 (5.7%) recurrent stroke events documented during a mean follow-up of 7.6 years. Using Cox proportional hazards regression model with restricted cubic splines, a quasi J-shaped relationship between 25(OH)D and risk of recurrent stroke was found, where the lowest recurrent stroke risk lay at the 25(OH)D level of approximate 60 nmol/L. When compared with 10 nmol/L, a 25(OH)D level of 60 nmol/L was related with a 48% reduction in the recurrent stroke risk (hazard ratio = 0.52, 95% confidence interval: 0.33-0.83). Based on data from a large-scale prospective cohort, we found a quasi J-shaped relationship between 25(OH)D and risk of recurrent stroke in patients with a stroke history. Given a lack of exploring the cause-effect relationship in this observational study, more high-quality evidence is needed to further clarify the vitamin D status in relation to recurrent stroke risk.
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Affiliation(s)
- Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou 510317, China; (L.L.); (R.W.)
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Likang Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou 510317, China; (L.L.); (R.W.)
| | - Jonathan D. Adachi
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Ruoting Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou 510317, China; (L.L.); (R.W.)
| | - Zebing Ye
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China;
| | - Xintong Liu
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China;
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON L8S 4L8, Canada;
- Centre for Evaluation of Medicines, St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 3BX, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Calcitriol ameliorates brain injury in the rat model of cerebral ischemia-reperfusion through Nrf2/HO-1 signalling axis: An in silico and in vivo study. J Stroke Cerebrovasc Dis 2022; 31:106331. [PMID: 35306470 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Calcitriol has been revealed to exert neuroprotective effects in ischemic stroke; however, its role and the underlying mechanisms in brain injury induced by ischemia are not well known. The purpose of this study was to determine the neuroprotective effects of calcitriol pretreatment and to assess the possible neuroprotective function of nuclear factor erythroid 2-related factor 2 (Nrf2)/ heme oxygenase-1 (HO-1) signalling pathway against brain ischemia/reperfusion (I/R) injury in the rat models which was followed by a bioinformatics approach. METHODS The experimental I/R model induction was performed in male Wistar rats for 1 h followed by 23 h reperfusion. Calcitriol was administered intraperitoneally for 7 days prior to stroke. Following ischemia induction 24 h later, neurobehavioral deficits and infarction volume were examined. Oxidative stress was assessed by measurement of malondialdehyde (MDA), nitric oxide (NO) and total antioxidant capacity (TAC). The protein and mRNA expression of HO-1 and Nrf2 were determined by western blot and reverse transcription polymerase chain reaction (RT-PCR), respectively. A molecular docking approach was applied to identify the interaction value of Keap1 with calcitriol. RESULTS Our data demonstrated that calcitriol significantly decreased infarction volume and ameliorated neurological deficits in brain I/R. MDA and NO levels were decreased and TAC level was elevated significantly after calcitriol pretreatment. Furthermore, calcitriol upregulated the expression of HO-1 and Nrf2 protein and mRNA in ischemic brain. Molecular modelling demonstrated that calcitriol could interact with the pocket of Keap1 by an appropriate binding energy. CONCLUSIONS The results indicate that calcitriol protects the brain against I/R injury. This effect may pass through inhibition of oxidative stress and Nrf2/HO-1 pathway activation and this may arise by interaction of Keap1 and calcitriol.
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Association between Fok1 and TaqI polymorphisms of vitamin D receptor gene with the severity of stenosis and calcification in carotid bulb in patients with ischemic stroke. J Clin Neurosci 2022; 97:115-120. [DOI: 10.1016/j.jocn.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 01/19/2023]
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Saponaro F, Franzini M, Okoye C, Antognoli R, Campi B, Scalese M, Neri T, Carrozzi L, Monzani F, Zucchi R, Celi A, Paolicchi A, Saba A. Is There a Crucial Link Between Vitamin D Status and Inflammatory Response in Patients With COVID-19? Front Immunol 2022; 12:745713. [PMID: 35140702 PMCID: PMC8818986 DOI: 10.3389/fimmu.2021.745713] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Hypovitaminosis D has been suggested to play a possible role in coronavirus disease 2019 (COVID-19) infection. Methods The aim of this study is to analyze the relationship between vitamin D status and a biochemical panel of inflammatory markers in a cohort of patients with COVID-19. A secondary endpoint was to evaluate the correlation between 25OHD levels and the severity of the disease. Ninety-three consecutive patients with COVID-19-related pneumonia were evaluated from March to May 2020 in two hospital units in Pisa, in whom biochemical inflammatory markers, 25OHD levels, P/F ratio at nadir during hospitalization, and complete clinical data were available. Results Sixty-five percent of patients presented hypovitaminosis D (25OHD ≤ 20 ng/ml) and showed significantly higher IL-6 [20.8 (10.9-45.6) vs. 12.9 (8.7-21.1) pg/ml, p = 0.02], CRP [10.7 (4.2-19.2) vs. 5.9 (1.6-8.1) mg/dl, p = 0.003], TNF-α [8.9 (6.0-14.8) vs. 4.4 (1.5-10.6) pg/ml, p = 0.01], D-dimer [0.53 (0.25-0.72) vs. 0.22 (0.17-0.35) mg/l, p = 0.002], and IL-10 [3.7 (1.8-6.9) vs. 2.3 (0.5-5.8) pg/ml, p = 0.03]. A significant inverse correlation was found between 25OHD and all these markers, even adjusted for age and sex. Hypovitaminosis D was prevalent in patients with severe ARDS, compared with the other groups (75% vs. 68% vs. 55%, p < 0.001), and 25OHD levels were lower in non-survivor patients. Conclusions The relationship between 25OHD levels and inflammatory markers suggests that vitamin D status needs to be taken into account in the management of these patients. If vitamin D is a marker of poor prognosis or a possible risk factor with beneficial effects from supplementation, this still needs to be elucidated.
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Affiliation(s)
- Federica Saponaro
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Maria Franzini
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Chukwuma Okoye
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rachele Antognoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Beatrice Campi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Tommaso Neri
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Riccardo Zucchi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Celi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Aldo Paolicchi
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Saba
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Wei Y, Xu B, Wang Z, Zhou Z, Liu L, Lin T, Song Y, Li J, Zhang Y, Huo Y, Mao G, Wang B, Tang G, Qin X, Zhang H, Wang X, Guo H, Xu X. Joint Associations between Plasma 25-Hydroxyvitamin D, Glycemic Status, and First Stroke in General Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT). J Nutr 2022; 152:246-254. [PMID: 34558624 DOI: 10.1093/jn/nxab339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/10/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Associations between vitamin D and stroke remain inconsistent. One major risk factor for stroke is high blood glucose, but the role it plays in this association is not well studied. OBJECTIVES We aimed to evaluate the individual association between plasma 25-hydroxyvitamin D [25(OH)D] and risk of first stroke stratified by fasting blood glucose (FBG), and the joint associations between plasma 25(OH)D, glycemic status, and first stroke in hypertensive adults. METHODS This study was a nested, case-control design utilizing data from the China Stroke Primary Prevention Trial (CSPPT). This analysis included 591 first stroke cases (of which 475 were ischemic stroke, 114 were hemorrhagic stroke, and 2 were uncertain type) and 591 matched controls. The age range of the study population was 45-75 y. The normal FBG (NFG) group had FBG <5.6 mmol/L, and the impaired FBG (IFG) group had FBG ≥5.6 mmol/L and <7.0 mmol/L. Diabetes was defined as participants with FBG ≥7 mmol/L or who were receiving treatment with hypoglycemic agents. ORs (95% CIs) were calculated using unconditional logistic regression models. RESULTS Multivariable adjusted models revealed an inverse association between quartiles of 25(OH)D and risk of first stroke among participants with NFG, but the opposite trend was observed for those with IFG or diabetes. The largest ORs (>2) were observed among patients with diabetes, compared with the reference group of NFG and high 25(OH)D. Those with NFG and low 25(OH)D (OR = 1.73, 95% CI: 1.22 to 2.44) or those with IFG and high 25(OH)D (OR = 1.74, 95% CI: 1.14 to 2.67) both had a higher risk of total stroke. There was a significant interaction between 25(OH)D and a combined group of IFG and diabetes (P = 0.001). Similar results were observed for ischemic stroke. CONCLUSIONS In a hypertensive population, the relation between plasma 25(OH)D and risk of first stroke was significantly modified by FBG. This trial was registered at https://www.clinicaltrials.gov as NCT00794885.
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Affiliation(s)
- Yaping Wei
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Benjamin Xu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zhuo Wang
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Ziyi Zhou
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lishun Liu
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Tengfei Lin
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yun Song
- Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Guangyun Mao
- Department of Preventive Medicine, School of Public Health & Management, Wenzhou Medical University, Wenzhou, China
| | - Binyan Wang
- Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Genfu Tang
- Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China
| | - Hao Zhang
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Huiyuan Guo
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiping Xu
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China.,Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China
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Wang L, Zhao XM, Wang FY, Wu JC, Wang Y. Effect of Vitamin D Supplementation on the Prognosis of Post-stroke Fatigue: A Retrospective Cohort Study. Front Neurol 2021; 12:690969. [PMID: 34803866 PMCID: PMC8602338 DOI: 10.3389/fneur.2021.690969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We aimed to evaluate the effect of vitamin D supplementation in post-stroke fatigue (PSF) patients with vitamin D deficiency on fatigue symptoms and outcomes. Methods: Patients with primary acute ischemic stroke (AIS) were recruited consecutively from July 2016 to June 2018. Post-stroke fatigue patients were screened out with the Fatigue Severity Scale (FSS) questionnaire, serum concentrations of 25-hydroxyvitamin D [25-(OH)-D] were assessed with enzyme-linked immunosorbent assay (ELISA), and neurological function was evaluated with FSS and modified Rankin Scale (mRS) scoring criteria. Post-stroke fatigue patients with vitamin D deficiency were divided into two groups: a study group in which patients received vitamin D supplementation (cholecalciferol, 600 IU/day) along with usual care, and a control group in which patients received usual care alone. At the end of 1 and 3 months after treatment, all PSE patients accepted re-measurement of serum vitamin D and re-evaluation of fatigue and neurological function. Results: A total of 532 AIS patients were consecutively recruited to participate in this study. Patients without PSF, non-vitamin D deficiency, pre-stroke fatigue, or vitamin D supplementation were excluded from the study. In addition, patients who were lost to follow-up were also excluded. Finally, 139 out of 532 (26.1%) patients with PSF and vitamin D deficiency received vitamin D supplementation treatment. Fatigue Severity Scale score was significantly lower in the study group than in the control group at 1 month (t = -4.731, p < 0.01) and 3 months (t = -7.937, p < 0.01) after treatment. One month after treatment, mRS score in the study group was lower than that in the control group without statistical difference (t = -0.660, p > 0.05), whereas mRS was significantly higher in the study group than in the control group at 3 months after treatment (t = -4.715, p < 0.01). Conclusions: Our results indicated that vitamin D supplementation could improve fatigue symptoms and neurological outcomes in PSF patients with vitamin D deficiency. Subject to replication in other settings, a randomized controlled trial (RCT) might be undertaken to validate the potential beneficial impact of vitamin D supplementation in post-stroke patients found to be vitamin D deficient.
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Affiliation(s)
- Long Wang
- Department of Neurology, The Second People's Hospital of Hefei, Hefei, China.,Department of Neurology, General Hospital of Wan Bei Coal and Electrical Group, Suzhou, China
| | - Xue-Min Zhao
- Department of Neurology, General Hospital of Wan Bei Coal and Electrical Group, Suzhou, China
| | - Fu-Yu Wang
- Department of Pharmacy, The Second People's Hospital of Hefei, Hefei, China
| | - Jun-Cang Wu
- Department of Neurology, The Second People's Hospital of Hefei, Hefei, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Liu D, Meng X, Tian Q, Cao W, Fan X, Wu L, Song M, Meng Q, Wang W, Wang Y. Vitamin D and Multiple Health Outcomes: An Umbrella Review of Observational Studies, Randomized Controlled Trials, and Mendelian Randomization Studies. Adv Nutr 2021; 13:1044-1062. [PMID: 34999745 PMCID: PMC9340982 DOI: 10.1093/advances/nmab142] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/29/2020] [Accepted: 11/19/2021] [Indexed: 12/18/2022] Open
Abstract
Observational studies, randomized controlled trials (RCTs), and Mendelian randomization (MR) studies have yielded inconsistent results on the associations of vitamin D concentrations with multiple health outcomes. In the present umbrella review we aimed to evaluate the effects of low vitamin D concentrations and vitamin D supplementation on multiple health outcomes. We summarized current evidence obtained from meta-analyses of observational studies that examined associations between vitamin D concentrations and multiple health outcomes, meta-analyses of RCTs that investigated the effect of vitamin D supplementation on multiple health outcomes, and MR studies that explored the causal associations of vitamin D concentrations with various diseases (international prospective register of systematic reviews PROSPERO registration number CRD42018091434). A total of 296 meta-analyses of observational studies comprising 111 unique outcomes, 139 meta-analyses of RCTs comprising 46 unique outcomes, and 73 MR studies comprising 43 unique outcomes were included in the present umbrella review. Twenty-eight disease outcomes were identified by both meta-analyses of observational studies and MR studies. Seventeen of these reported disease outcomes had consistent results, demonstrating that lower concentrations of vitamin D were associated with a higher risk for all-cause mortality, Alzheimer's disease, hypertension, schizophrenia, and type 2 diabetes. The combinations of consistent evidence obtained by meta-analyses of observational studies and MR studies together with meta-analyses of RCTs showed that vitamin D supplementation was associated with a decreased risk for all-cause mortality but not associated with the risk for Alzheimer's disease, hypertension, schizophrenia, or type 2 diabetes. The results indicated that vitamin D supplementation is a promising strategy with long-term preventive effects on multiple chronic diseases and thus has the potential to decrease all-cause mortality. However, the current vitamin D supplementation strategy might not be an efficient intervention approach for these diseases, suggesting that new strategies are highly needed to improve the intervention outcomes.
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Affiliation(s)
- Di Liu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,Centre for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Xiaoni Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Weijie Cao
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xin Fan
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Lijuan Wu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Manshu Song
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Qun Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia,School of Public Health, Shandong First Medical University and Shandong Academy of Medical Science, Tai'an, Shandong, China
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Torrisi M, Bonanno L, Formica C, Arcadi FA, Cardile D, Cimino V, Bramanti P, Morini E. The role of rehabilitation and vitamin D supplementation on motor and psychological outcomes in poststroke patients. Medicine (Baltimore) 2021; 100:e27747. [PMID: 34766589 PMCID: PMC8589234 DOI: 10.1097/md.0000000000027747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/25/2021] [Indexed: 01/05/2023] Open
Abstract
Post-Stroke depression affects between 12% and 72% of patients who have suffered a stroke. The association between low serum levels of 25-hydroxyvitamin D (25(OH) D) and increased risk of depression is reported in both stroke and non-stroke patients. Similarly, high 25(OH) D levels might be associated with greater functional improvement during rehabilitation program.We wanted to investigate the effects of an intensive rehabilitation on poststroke outcomes. We wondered if the daily rehabilitation of motor and cognitive functions could also have an effect on mood and functional abilities in addition to or as an alternative to vitamin D supplementation.We conducted a 12-week, randomized trial, double blind, parallel, monocentric clinical trial of 40 patients undergoing intensive neuro-rehabilitation treatment at a specialized care facility for ischemic or hemorrhagic brain stroke. Participants were randomly assigned, in a 1:1 ratio, to 1 of 2 parallel groups: in the experimental group, 2000 IU/day of oral cholecalciferol was administered; in the control group patients were not taking vitamin D supplementation. Patients underwent a text evaluation to investigate psychological and motor outcomes.Significant intra-group difference in outcomes measures was found but not between control group and experimental group. In the vitamin D group, we highlighted significant differences between T0 and T1 in calcium (P < .001), vitamin D (P < .001), in Montgomery Aasberg Depression Rating Scale (P = .001), and in Functional Independent Measures (P < .001). In the health control group, we found a significant difference in calcium (P = .003), vitamin D (P < .001), Montgomery Aasberg Depression Rating Scale (P = 0.006), in general self-efficacy (P = .009), and in Functional Independent Measures (P < .001).Our results show that the beneficial effect on mood and functional recovery is mainly due to neurorehabilitation rather than vitamin D supplementation.
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Association between Serum 25-Hydroxyvitamin D Level and Stroke Risk: An Analysis Based on the National Health and Nutrition Examination Survey. Behav Neurol 2021; 2021:5457881. [PMID: 34745384 PMCID: PMC8570893 DOI: 10.1155/2021/5457881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background To analyze the association between serum 25-hydroxyvitamin D level (25(OH)D) and stroke risk based on the National Health and Nutrition Examination Survey (NHANES). Methods Between 2007 and 2018, the baseline information of participants from NHNES was collected. Univariate analysis was used to identify the covariates. Multivariate logistic regression model was used to analyze the association between serum 25(OH)D level and the stroke risk. Results Of the 8,523 participants, there were 310 participants with stroke and 8,213 participants without stroke. The multivariate logistic analysis showed that serum 25(OH)D deficiency (odds ratio (OR): 1.993, 95% confidence intervals (CI): 1.141-3.481, and P = 0.012) was the significant risk factors for stroke. Subgroup analysis showed that non-Hispanic whites with serum 25(OH)D deficiency (OR: 2.501, 95% CI: 1.094-5.720, and P = 0.001) and insufficiency (OR: 1.853, 95% CI: 1.170-2.934, and P = 0.006) were associated with a higher risk of stroke than those with normal 25(OH)D levels. Conclusions Serum 25(OH)D deficiency may be associated with an increased risk of stroke.
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Yang L, Zhao H, Liu K, Wang Y, Liu Q, Sun T, Chen S, Ren L. Smoking behavior and circulating vitamin D levels in adults: A meta-analysis. Food Sci Nutr 2021; 9:5820-5832. [PMID: 34646549 PMCID: PMC8497833 DOI: 10.1002/fsn3.2488] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/20/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022] Open
Abstract
To determine the effect of smoking on circulating vitamin D in adults, we performed a meta-analysis. Literature before 9 May 2021 was retrieved from electronic literature databases such as EMBASE, PubMed, and Cochrane. The quality of the included studies was assessed by two researchers against the Newcastle-Ottawa scale and JBI Evidence-based Health Care Centre criteria. All eligible studies and statistical analyses were performed using STATA 14. Twenty-four studies with 11,340 participants meeting the criteria were included in the meta-analysis. The results of meta-analysis showed that the level of circulating 25(OH)D in smokers was lower than that in nonsmokers. A subgroup analysis based on vitamin D supplement use showed that both smokers who used vitamin D supplements and smokers who did not use vitamin D supplements had lower blood 25(OH)D levels compared with the control group. In addition, subjects were divided into different subgroups according to age for meta-analysis, and the results showed that the serum 25(OH)D level in each subgroup of smokers was lower than that in the control group. This meta-analysis revealed differences in circulating vitamin D levels between smokers and nonsmokers, with smokers likely to have lower circulating vitamin D levels.
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Affiliation(s)
- Lu Yang
- Hebei General HospitalShijiazhuangChina
| | - Hang Zhao
- Hebei General HospitalShijiazhuangChina
| | - Ke Liu
- Hebei General HospitalShijiazhuangChina
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Dudenkov DV, Mara KC, Maxson JA, Thacher TD. Serum 25-hydroxyvitamin D values and risk of incident cardiovascular disease: A population-based retrospective cohort study. J Steroid Biochem Mol Biol 2021; 213:105953. [PMID: 34274459 PMCID: PMC9835011 DOI: 10.1016/j.jsbmb.2021.105953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/15/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Concentrations of serum 25-hydroxyvitamin D [25(OH)D] below 20 ng/mL and above 50 ng/mL have been associated with chronic adverse events including cardiovascular disease. OBJECTIVE To conduct a comprehensive population-based study in the United States of the relationship of low and high serum 25(OH)D levels with cardiovascular disease. METHODS We identified all serum 25(OH)D measurements in adults age 18 years and older residing in Olmsted County, MN between January 1, 2005 and December 31, 2011, using the resources of the Rochester Epidemiology Project. Any new diagnosis of cardiovascular disease was the primary outcome, and time zero was 30 days after first 25(OH)D measurement. Patients were followed until their last clinical visit as an Olmsted County resident, December 31, 2014, or death. Categories of 25(OH)D values were examined using predetermined ranges of interest: <12, 12-19, 20-50 (reference range), and >50 ng/mL. Multivariable Cox proportional hazards models were adjusted for age, BMI, sex, race, smoking history, season of 25(OH)D measurement, hypertension, hyperlipidemia, socioeconomic status and Charlson comorbidity index at time of 25(OH)D measurement. RESULTS A total of 11,002 unique persons had a 25(OH)D measurement, with a mean (±SD) value of 30.0 ± 12.9 ng/mL. Mean age was 54.3 ± 17.2 years, and the majority were female (77.1 %) and white (87.6 %). There were 4124 new diagnoses of cardiovascular disease in this cohort after a median overall follow-up of 4.8 years (IQR 3.4-6.2). Adjusted cardiovascular disease hazard ratios (HRs) (95 % confidence interval) for 25(OH)D values <12, 12-19, and >50 ng/mL, compared to the reference range 20-50 ng/mL, were 1.28 (1.12-1.46), 1.19 (1.09-1.31), and 1.10 (0.95-1.26), respectively. CONCLUSION Values of 25(OH)D <20 ng/mL were associated with development of a new diagnosis of cardiovascular disease. There was no significant association between 25(OH)D values >50 ng/mL and cardiovascular disease.
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Affiliation(s)
- Daniel V Dudenkov
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
| | - Kristin C Mara
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Julie A Maxson
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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Su C, Jin B, Xia H, Zhao K. Association between Vitamin D and Risk of Stroke: A PRISMA-Compliant Systematic Review and Meta-Analysis. Eur Neurol 2021; 84:399-408. [PMID: 34325429 DOI: 10.1159/000517584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have shown inconsistent results for associations between vitamin D and risk of stroke. We gathered the existing published articles and conducted this meta-analysis with the aim to explore the association between vitamin D and risk of stroke. METHODS We searched for articles exploring the association between vitamin D and risk of stroke and published before April 2021 in the following databases: PubMed, Web of Science, MEDLINE, EMBASE, and Google Scholar. All statistical analyses were made using STATA 12.0 software. Q test and I2 were applied to examine heterogeneities between studies. RESULTS For the association between serum levels of 25(OH) vitamin D and risks of stroke, the present analysis included 20 cohort studies (including 213,276 participants) and a case-control analysis (including 13,642 participants). Additionally, the analysis included 15 studies (including 41,146 participants given vitamin D supplementation and 41,163 participants given placebo) to evaluate the influence of vitamin D supplementation on risk of stroke. Higher circulating levels of 25(OH) vitamin D were associated with a reduced risk of stroke (odds ratio/relative risk = 0.78, 95% confidence interval [CI]: 0.70-0.86, I2 = 41.5%, p = 0.025). However, the present analysis showed that vitamin D supplementation did not influence the risk of stroke (hazard ratio = 1.05, 95% CI: 0.96-1.14, I2 = 2.3%, p = 0.425). CONCLUSIONS Our analysis indicated that lower circulating level of vitamin D was associated with an elevated risk of stroke, but extra supplement of vitamin D failed to show benefit in decreasing the risk of stroke. Further research and study are also needed to show the role of vitamin D in relation to stroke.
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Affiliation(s)
- Cen Su
- Department of Neurology, Fourth People's Hospital of Zhenjiang, Zhenjiang, China
| | - Biao Jin
- Department of Neurology, Fourth People's Hospital of Zhenjiang, Zhenjiang, China
| | - Haiping Xia
- Department of Neurology, Fourth People's Hospital of Zhenjiang, Zhenjiang, China
| | - Kangren Zhao
- Department of Neurology, Fourth People's Hospital of Zhenjiang, Zhenjiang, China
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Wei S, Yuan X, Fan F, Guo XB, Guan S. The relationship between the level of vitamin D and ruptured intracranial aneurysms. Sci Rep 2021; 11:11881. [PMID: 34088910 PMCID: PMC8178395 DOI: 10.1038/s41598-021-90760-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 12/05/2022] Open
Abstract
The purpose of our research is to explore whether vitamin D levels were associated with the rupture of intracranial aneurysms. In this retrospective study, 105 patients diagnosed with ruptured intracranial aneurysms (RIAs) and 185 patients diagnosed with unruptured intracranial aneurysms (UIAs) at The First Affiliated Hospital of Zhengzhou University were recruited from September 2019 to September 2020. Patients’ demographic and clinical information, including vitamin D levels, were recorded and compared. Univariate analysis showed that patients with UIAs had higher vitamin D levels than RIAs (p = 0.019). In addition, there were significant differences in aneurysm location (p < 0.001), aspirin use (p = 0.001), and comorbid diabetes mellitus (p = 0.037) between patients with UIAs and RIAs. Binary logistic regression analysis showed that the level of vitamin D was independently associated with RIAs [odds ratio (OR) 0.960; 95% confidence intervals (CI), 0.926–0.996, p = 0.028].
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Affiliation(s)
- Sen Wei
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xin Yuan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Feng Fan
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xin-Bin Guo
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Sheng Guan
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Chang YM, Wang CM, Lin PY, Sung PS, Lin SH, Chen CH. Simple but Organized Neurology Residency Training Improves the Quality of Acute Stroke Care: From the Outset to Long-Term Effect. J Stroke 2021; 23:293-295. [PMID: 34102767 PMCID: PMC8189861 DOI: 10.5853/jos.2020.04910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/19/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yu-Ming Chang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Min Wang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Yu Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Yousuf S, Atif F, Espinosa-Garcia C, Harris W, Turan N, Stein DG. Stroke-Induced Peripheral Immune Dysfunction in Vitamin D-Deficient Conditions: Modulation by Progesterone and Vitamin D. Mol Neurobiol 2021; 58:950-963. [PMID: 33063282 DOI: 10.1007/s12035-020-02129-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
Vitamin D deficiency (Ddef) alters morphology and outcomes after a stroke. We investigated the interaction of Ddef following post-stroke systemic inflammation and evaluated whether administration of progesterone (P) or vitamin D (D) will improve outcomes. Ddef rats underwent stroke with lipopolysaccharide (LPS)-induced systemic inflammation. Rats were randomly divided into 9 groups and treated with P, D, or vehicle for 4 days. At day 4, rats were tested on different behavioral parameters. Markers of neuronal inflammation, endoplasmic reticulum stress, oxidative stress, white matter integrity, and apoptosis were measured along with immune cell populations from the spleen, thymus, and blood. Severely altered outcomes were observed in the Ddef group compared to the D-sufficient (Dsuf) group. Stroke caused peripheral immune dysfunction in the Dsuf group which was worse in the Ddef group. Systemic inflammation exacerbated injury outcomes in the Dsuf group and these were worse in the Ddef group. Monotherapy with P/D showed beneficial functional effects but the combined treatment showed better outcomes than either alone. Ddef as a comorbid condition with stroke worsens stroke outcomes and can delay functional recovery. Combination treatment with P and D might be promising for future stroke therapeutics in Ddef.
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Affiliation(s)
- Seema Yousuf
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, 615 Michael Street, Room 655A, Atlanta, GA, 30322, USA.
| | - Fahim Atif
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, 615 Michael Street, Room 655A, Atlanta, GA, 30322, USA
| | | | - Wayne Harris
- School of Medicine, Department of Hematology-Oncology, Emory University, Atlanta, GA, 30322, USA
| | - Nefize Turan
- Department of Neurology, School of Medicine, Tufts University, Boston, MA, 0211, USA
| | - Donald G Stein
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, 615 Michael Street, Room 655A, Atlanta, GA, 30322, USA
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Kostoglou-Athanassiou I. Vitamin D and Chronic Kidney Disease. Int J Prev Med 2021; 12:15. [PMID: 34084312 PMCID: PMC8106285 DOI: 10.4103/ijpvm.ijpvm_97_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 01/23/2020] [Indexed: 11/29/2022] Open
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Kaul S, Manikinda J. Role of Vitamin D in Cerebrovascular Disease. Ann Indian Acad Neurol 2021; 24:142-145. [PMID: 34220055 PMCID: PMC8232472 DOI: 10.4103/aian.aian_928_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/09/2020] [Accepted: 11/03/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Vitamin D deficiency is now a well-recognized public health problem affecting almost every second person throughout the world. Recent evidence from many population-based studies has indicated that a poor vitamin D status is a predictor of future strokes. Materials and Methods We reviewed recent studies on 25-hydroxyvitamin D [25(OH)D] and symptomatic ischemic stroke. A graded increase in the risk of symptomatic ischemic stroke with decreasing levels of plasma 25(OH)D has been found in most of the studies. Vitamin D also has a role in the poststroke period where its deficiency may hinder the rehabilitation process. Conclusions After reviewing current literature on the subject, we conclude that there are some data to suggest the role of vitamin D in patients with stroke but it cannot be concluded as a risk factor for stroke. Larger population-based studies are needed to confirm the causative role of vitamin D in stroke.
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Affiliation(s)
- Subhash Kaul
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Jayasree Manikinda
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Miao H, Zhu H, Luan X, Huang G, Chen M, Yuan Z, Wang Z. Risk Factors of Vitamin D Deficiency in Chinese Ischemic Stroke Patients: A Cross-Sectional Study. Front Aging Neurosci 2021; 12:613498. [PMID: 33536895 PMCID: PMC7849025 DOI: 10.3389/fnagi.2020.613498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Lower serum vitamin D has been reported to be associated with stroke. This study aimed to analyze the risk factors of vitamin deficiency in Chinese stroke patients, and further analyze its impact in different gender and their clinical variables. Methods 982 stroke patients were enrolled. Laboratory parameters such as serum vitamin D, apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB), ApoA-I/ApoB, cholesterol (CH), fibrinogen (FIB), blood glucose (Glu), high-density lipoprotein (HDL), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were collected and recorded. The severity of stroke was assessed by National Institute of Health Stroke Scale (NIHSS) score. Based on their serum vitamin D level, patients were divided into three groups: Vitamin D deficiency (<50 nmol/L), vitamin D insufficiency (≥50–75 nmol/L) and vitamin D sufficiency (≥75 nmol/L) and differences were compared among the three groups. Statistical analyses were done to assess the risk factors for serum vitamin D deficiency in our ischemic stroke patients. Results Gender, NIHSS, and FIB showed significant differences among the vitamin D groups (P < 0.001 ∼ P = 0.002). The female gender (OR = 2.422, P < 0.001), severity of stroke using NIHSS (OR = 1.055, P = 0.008) and FIB (OR = 1.256, P = 0.005) were risk factors of vitamin D deficiency in ischemic stroke patients. In subgroup analysis, NIHSS was significantly associated with vitamin D deficiency in the male group (OR = 1.087, P = 0.002) and higher FIB group (OR = 1.078, P = 0.001). Conclusions The female gender, severity of stroke using NIHSS and FIB were risk factors for vitamin D deficiency in our incident stroke patients. NIHSS was more sensitive to vitamin D deficiency in male ischemic stroke patients. Besides, under higher FIB circumstance, the increasing NIHSS score was more related to the vitamin D deficiency. Levels of vitamin D in patients with ischemic stroke should be well monitored during the disease cascade.
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Affiliation(s)
- Hanpei Miao
- Department of Ophthalmology, Wenzhou Medical University, Wenzhou, China
| | - Hanyu Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meixia Chen
- Department of Neurology, The Yuhuan People's Hospital, Taizhou, China
| | - Zhengzhong Yuan
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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High-phosphorus diets reduce aortic lesions and cardiomyocyte size and modify lipid metabolism in Ldl receptor knockout mice. Sci Rep 2020; 10:20748. [PMID: 33247205 PMCID: PMC7695849 DOI: 10.1038/s41598-020-77509-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
The consumption of phosphorus in Western populations largely exceeds the recommended intake, while vitamin D supply is often insufficient. Both situations are linked to an increased cardiovascular risk. A 17-week two-factorial study with Ldl receptor-/- mice was conducted to investigate the cardiovascular impact of dietary phosphorus [adequate (0.3%; P0.3) vs. high (1.5%; P1.5)] in combination with a low (50 IU/kg; D50) or adequate vitamin D diet (1000 IU/kg; D1000). The data demonstrate that mice fed the P1.5 vs. P0.3 diets developed smaller vascular lesions (p = 0.013) and cardiac hypotrophy (p = 0.011), which were accompanied by diminished IGF1 and insulin signalling activity in their hearts. Vitamin D showed no independent effect on atherogenesis and heart morphology. Feeding P1.5 vs. P0.3 diets resulted in markedly reduced serum triacylglycerols (p < 0.0001) and cholesterol (p < 0.0001), higher faecal lipid excretion (p < 0.0001) and a reduced mRNA abundance of hepatic sterol exporters and lipoprotein receptors. Minor hypocholesterolaemic and hypotriglyceridaemic effects were also found in mice fed the D1000 vs. D50 diets (p = 0.048, p = 0.026). To conclude, a high phosphorus intake strongly affected the formation of vascular lesions, cardiac morphology, and lipid metabolism, although these changes are not indicative of an increased cardiovascular risk.
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Saponaro F, Saba A, Zucchi R. An Update on Vitamin D Metabolism. Int J Mol Sci 2020; 21:ijms21186573. [PMID: 32911795 PMCID: PMC7554947 DOI: 10.3390/ijms21186573] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/22/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Vitamin D is a steroid hormone classically involved in the calcium metabolism and bone homeostasis. Recently, new and interesting aspects of vitamin D metabolism has been elucidated, namely the special role of the skin, the metabolic control of liver hydroxylase CYP2R1, the specificity of 1α-hydroxylase in different tissues and cell types and the genomic, non-genomic and epigenomic effects of vitamin D receptor, which will be addressed in the present review. Moreover, in the last decades, several extraskeletal effects which can be attributed to vitamin D have been shown. These beneficial effects will be here summarized, focusing on the immune system and cardiovascular system.
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Kumar M, Nishad DK, Kumar A, Bhatnagar A, Karwasra R, Khanna K, S K, Sharma D, Dua K, Mudaliyar V, Sharma N. Enhancement in brain uptake of vitamin D 3 nanoemulsion for treatment of cerebral ischemia: formulation, gamma scintigraphy and efficacy study in transient middle cerebral artery occlusion rat models. J Microencapsul 2020; 37:492-501. [PMID: 32715833 DOI: 10.1080/02652048.2020.1801870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM For the treatment of cerebral ischaemia, vitamin-D3 loaded nanoemulsions were developed. METHOD Tween 20 and polyethylene glycol were chosen as surfactant/co-surfactant, while oleic acid as the oil phase. The formulation was characterised for various in-vitro parameters. Targeting efficiency was investigated through radiometry, gamma scintigraphy and efficacy was studied in transient middle cerebral artery occlusion (MCAo) rat model. RESULT Vitamin D3-nanoemulsion showed a mean size range of 49.29 ± 10.28 nm with polydispersity index 0.17 ± 0.04 and zeta potential 13.77 mV. The formulation was found stable during thermodynamic stability study and permeated within 180 min through sheep nasal mucosa (permeation coefficient 7.873 ± 0.884 cm/h). Gamma scintigraphy and radiometry assay confirmed better percentage deposition (2.53 ± 0.17%) of 99mTc-vitamin D3-nanoemulsion through nasal route compared to IV administered 99mTc-vitamin D3 solution (0.79 ± 0.03%). Magnetic Resonance Imaging (MRI) of the ischaemic model confirmed better efficacy of vitamin D3-nanoemulsion. CONCLUSION This work demonstrated better permeation, deposition, and efficacy of vitaminD3-nanoemulsion through the intranasal route.
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Affiliation(s)
- Mukesh Kumar
- Department of Pharmaceutical Technology, Meerut Institute of Engineering & Technology, Meerut, India.,Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Dhruv Kumar Nishad
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Anoop Kumar
- Department of Pharmaceutical Technology, Meerut Institute of Engineering & Technology, Meerut, India
| | - Aseem Bhatnagar
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Ritu Karwasra
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Kushagra Khanna
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Keerthana S
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Deeksha Sharma
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia.,Centre for Inflammation, Centenary Institute, Royal Prince Alfred Hospital, Sydney, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI) & School of Biomedical Sciences and Pharmacy, The University of Newcastle (UoN), Callaghan, Australia
| | - Vijaybabu Mudaliyar
- Department of Pharmaceutical Technology, Meerut Institute of Engineering & Technology, Meerut, India
| | - Nitin Sharma
- Department of Pharmaceutical Technology, Meerut Institute of Engineering & Technology, Meerut, India.,Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
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Cui P, Wang Y, Li Y, Ge L. Vitamin D Attenuates Hypoxia-Induced Injury in Rat Primary Neuron Cells through Downregulation of the Dual Oxidase 1 (DUOX1) Gene. Med Sci Monit 2020; 26:e925350. [PMID: 32712621 PMCID: PMC7405618 DOI: 10.12659/msm.925350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study aimed to investigate the mechanisms underlying the neuroprotective effects of vitamin D. MATERIAL AND METHODS Rat primary neuron cells were incubated under a hypoxia condition [a hypoxic chamber mixed with anaerobic gas (90% N₂, 5% CO₂) and 5% O₂] to induce cell injury. Cell transfection was performed to overexpress or suppress the expression of dual oxidase 1 (DUOX1). The malondialdehyde (MDA) and superoxide dismutase (SOD) levels were detected using a MDA (A003-2) or SOD (A001-1) kit. DUOX1 mRNA levels were detected using RT-PCR. Hypoxia-inducible factor-1alpha (HIF-1alpha), DUOX1, vitamin D receptor (VDR), NF-kappaB protein expressions were determined by western blotting. Cell apoptosis and reactive oxygen species (ROS) were evaluated by flow cytometry. RESULTS ROS increased significantly after hypoxic treatment. The expressions of HIF-1alpha and DUOX1 were significantly increased after hypoxic treatment. Vitamin D could decrease ROS level, apoptotic neuron cells and DUOX1 expression, and increase VDR expression. Downregulation of DUOX1 significantly decreased MDA level and apoptotic percentages of neuron cells, increased SOD level, and counteracted the hypoxia-induced increase of NF-kappaB signal. Further study showed that overexpression of DUOX1 significantly increased MDA level, ROS level, apoptotic percentages of neuron cells, and NF-kappaB nuclear signaling, while decreased SOD level. Vitamin D significantly counteracted the effects of DUOX1 overexpression induced injury in rat primary neuron cells. CONCLUSIONS Our study indicated that vitamin D may protect neuron cells from hypoxia-induced injury by regulating DUOX1 via the NF-kappaB signaling pathway.
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Affiliation(s)
- Panpan Cui
- Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, Shandong, P.R. China
- Ear, Nose, Throat (ENT) Department, People’s Hospital of Rizhao, Rizhao, Shandong, P.R. China
| | - Yan Wang
- Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, Shandong, P.R. China
| | - Yanzhong Li
- Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, Shandong, P.R. China
| | - Lei Ge
- Department of Emergency, People’s Hospital of Rizhao, Rizhao, Shandong, P.R. China
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