|Year : 2021 | Volume
| Issue : 2 | Page : 130-131
Vitamin D and cerebrovascular disease
Rita Christopher1, Vijaya Majumdar2, D Nagaraja3
1 Department of Neurochemistry, NIMHANS, Bengaluru, India
2 S-VYASA, NIMHANS, Bengaluru, India
3 Department of Neurology, NIMHANS, Bengaluru, India
|Date of Submission||28-Nov-2020|
|Date of Acceptance||28-Nov-2020|
|Date of Web Publication||06-Apr-2021|
Prof. Rita Christopher
MD Professor of Neurochemistry, NIMHANS, Bengaluru 560 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Christopher R, Majumdar V, Nagaraja D. Vitamin D and cerebrovascular disease. Ann Indian Acad Neurol 2021;24:130-1
| Editorial Commentary|| |
Vitamin D (25-Hydroxyvitamin D (25(OH) D)), is a secosteroid provitamin obtained by dermal synthesis following exposure to sun and through oral consumption from food and supplements. Though initially related to bone and mineral homeostasis, a diversified range of physiological roles of 25(OH) D has been documented over the years. Concurrently, a vast array of >100 human diseases have been linked to low circulating concentrations of 25(OH) D. The intriguing but worrisome estimates of more than a half of global population with inadequate vitamin D status, suggest a vast potential for vitamin D-based interventions targeted at the prevention, and management of these diseases.
In the present point-of-view article, the authors have presented an epidemiological as well as clinical perspective on the incidence, severity, and rehabilitation of stroke caused by vitamin D deficiency. Although a decline in stroke mortality has been documented recently in developed nations because of the implementation of strict guidelines on risk factor management like hypertension,, the global burden of stroke continues to rise due to an increase in the developing countries. The authors have presented an overall view on the association of vitamin D status with stroke risk; most of the evidence discussed is derived from reported observational prospective studies. The authors have also given a run-through over the status of intervention studies; however, a few important reports could be included. To this end, we would like to refer to the recently published, randomized, placebo-controlled, VITAL trial, that reported no decrease in the incidence of cardiovascular events including stroke in the elderly, when the use of vitamin D supplements and marine omega-3 fatty acids were compared with placebo, during a mean follow-up of 5.3 years. The trial concluded that the beneficial influences of vitamin D supplementation on stroke risk could only be limited to severely vitamin D deficient individuals. The finding raises concerns on the implementation of vitamin D supplementation for the prevention of stroke. Similarly, the recent findings from a prospective, population-based study (n = 9680) from Rotterdam showed low circulating vitamin D in prevalent stroke but only severe vitamin D deficiency was linked to incident stroke. The study concluded with a view that lower vitamin D levels might not lead to higher stroke risk, but rather could be an outcome of stroke.
Given the inconsistent findings with a lack of reports on large sample sizes, the authors have indicated the limitations in inferring the causal association of vitamin D deficiency with stroke and have advocated that this should be explored in further studies. Authors have also opined that a plausible causal relationship between vitamin D deficiency and risk of stroke cannot be excluded based on a recently published Mendelian randomized study., In the referred study on 116,655 individuals, observational but not genetic low 25(OH)D concentration was linked to ischemic stroke; however, a causal relationship could be established between vitamin D deficiency and hypertension through the Mendelian randomization approach. An interesting mechanistic and epidemiological intersection lies between vitamin D levels, risk of stroke, and hypertension, one of the most prevalent pathophysiological risk factors for stroke. In a case–control study from China, the joint occurrence of vitamin D deficiency with hypertension was found to increase the probability of developing small vessel stroke by 5.6-fold [OR = 5.609 (95% CI 2.006–15.683)]. Similarly, in our cross-sectional evaluation in an Asian Indian population, the presence of hypertension was found to aggravate the risk of ischemic stroke associated with low vitamin D levels. We observed a distinct association between reduced circulating 25(OH)D and risk of ischemic stroke in hypertensives (OR = 13.54, 95% CI = 1.94–94.43) when compared to lack of association in non-hypertensives, (Pinteraction = 0.04). The synergistic influence of severely deficient vitamin D status along with hypertension on an aggravated stroke risk needs meticulous assessment in a prospective and interventional manner to answer the issue of combined treatment of low vitamin D levels and/or hypertension to prevent stroke and reduce the severity of its outcomes.
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