766Received July 18, 2016Accepted for publication August 24, 2016J Nutr Health AgingVolume 21, Number 7, 2017IntroductionStroke is a leading cause of death and disability in China and each year, 2.5 million people suffer a stroke (1). Survivors often require long-term care, and are at high risk of recurrent stroke. Vitamin D deficiency has been proposed as a risk factor for mild cognitive impairment (2), obesity (3), dementia (4) and cardiovascular disease (5). A study found that the majority of adult Italian population has an important deficiency in vitamin D (6). In our previous study, we found that vitamin D deficiency was common (78.2%) in ischemic stroke patients (7). Similarly, Rolland et al. (8) found that most residents in nursing homes have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. In addition, an increase in yearly trend of calcium and vitamin D supplements was observed in US population (9).Previous studies indicate that vitamin D deficiency is a risk factor for strokes (10, 11). Brøndum-Jacobsen et al. (12) observed stepwise increasing risk of symptomatic ischemic stroke with decreasing plasma 25-hydroxyvitamin D [25(OH) D] concentrations. The association between serum vitamin D status and functional outcomes, all-cause mortality and recurrent vascular events were observed in ischemic stroke patients (13-16). In a previous study, we demonstrated that 25(OH) D was an independent prognostic marker for functional outcome within 90 days in ischemic stroke patients (7). Thus, in this study, we determined 25(OH) D levels in serum, and investigated their associations with risk of recurrent stroke and mortality in a 24-month follow up study in Chinese patients with first-ever ischemic stroke.Subjects and MethodsPatientsThe study methods have been described elsewhere (7). Briefly, all patients were registered in two hospitals in Beijing, China. From February 1, 2010 to September 30, 2012, all consecutive patients with a first-ever AIS event were included. Patients were eligible for inclusion if they were admitted with an acute ischemic stroke and with symptom onset within 24 hours. During the inclusion period, 364 patients were registered. Acute ischemic stroke was diagnosed in 231 patients and 220 completed 3-month follow-up. However, these 220 patients were similar in terms of baseline characteristics [age (P=0.42), gender (P=0.77), NIHSS (P = 0.72), weight (P = 0.39) and live in rural areas (P=0.51)] compared to the overall cohort.Written informed consent was obtained from all patients; and, this study conformed to the principles of the Declaration of Helsinki was approved by the investigational review board of the China Rehabilitation Research Center. At baseline, VITAMIN D STATUS AND THE RISK OF RECURRENT STROKE AND MORTALITY IN ISCHEMIC STROKE PATIENTS: DATA FROM A 24-MONTH FOLLOW-UP STUDY IN CHINA H. QIU 1,2,3 , M. WANG 1,2,3 , D. MI 2,3,4 , J. ZHAO 1,2,3 , W. TU 5,6 , Q. LIU 51. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China; 2. China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China; 3. Beijing Key Laboratory of Translation Medicine for Cerebrovascular Diseases, Beijing, 100050, China; 4. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China; 5. Institute of radiation medicine, Academy of Medical Science & Peking Union Medical College, Tianjin, 300192, China; 6. China Rehabilitation Research Center, Beijing, 100068, China. Corresponding author: Jizong Zhao, No.6, Tiantanxili, Dongcheng District, Beijing 100050, P. R. China, Tel: 86-13701095698, zhaojz205@163.comAbstract: Purpose: In this study, we determined serum 25-hydroxyvitamin D [25(OH) D] levels in serum, and investigated their associations with risk of recurrent stroke and mortality in a 24-month follow up study in Chinese patients with first-ever ischemic stroke. Methods: In this preplanned post hoc analysis, serum levels of 25(OH) D and NIH stroke scale (NIHSS) were measured at the time of admission in a cohort of patients with ischemic stroke. We used logistic regression model to assess the relationship between 25(OH) D levels and risk recurrent stroke or mortality. Results: The follow-up rate was 98.2% in 220 stroke patients. Of 216 patients, 18.5% (95%CI: 13.3%-23.7%) patients had a stroke recurrence, and 30.1% (95% CI: 24.0%-36.2%) died. After adjustment for traditional risk factors, serum 25(OH) D levels were negatively associated with the risk of stroke recurrence (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.70–0.85; P < 0.001) and negatively associated with mortality during 24 months of follow-up (OR, 0.72; 95% CI, 0.64–0.80; P< 0.001). Compared with the first quartile of serum 25(OH) D levels, the ORs for stroke recurrence and mortality were as follows: second quartile, 0.80 (95% CI, 0.63–0.93) and 0.77 (95% CI, 0.65–0.89); third quartile, 0.42 (95% CI, 0.31–0.55) and 0.39 (95% CI, 0.30–0.52); fourth quartile, 0.12 (95% CI, 0.07–0.19) and 0.10 (95% CI, 0.06–0.15), respectively. Conclusions: Lower serum levels of 25(OH) D are independently associated with the stroke recurrence and mortality at 24 months in ischemic stroke patients.Key words: 25-hydroxyvitamin D, vitamin D, ischemic stroke, recurrent stroke, mortality.
