Conflicts of interest: None declared.
Letter to the editor
Vitamin D deficiency and its relation to underlying stroke etiology in ethnic Asian ischemic stroke patients
Article first published online: 20 JUN 2013
© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization
International Journal of Stroke
Volume 8, Issue 5, page E18, July 2013
How to Cite
De Silva, D. A., Talabucon, L. P., Ng, E. Y., Ang, E. S. L., Tan, E. K. and Lee, W. L. (2013), Vitamin D deficiency and its relation to underlying stroke etiology in ethnic Asian ischemic stroke patients. International Journal of Stroke, 8: E18. doi: 10.1111/j.1747-4949.2012.00958.x
- Issue published online: 20 JUN 2013
- Article first published online: 20 JUN 2013
Vitamin D deficiency increases stroke risk but there are limited data in relation to underlying stroke etiology. We examined the association of serum 25-hydroxyvitamin D (25-OHD) and stroke etiology in 144 Asian ischemic stroke patients (41% small artery, 14% large artery, 9% cardioembolic, 1% other and 35% undetermined etiology by TOAST classification). Serum 25-OHD was measured using Roche competitive electrochemiluminescence immunoassay from blood samples taken within 1 week of stroke.
The majority had vitamin D insufficiency (50–100 nmol/L) (55%) or deficiency (<50 nmol/L) (40%). Patients with large versus small artery stroke had lower median serum 25-OHD (48·4 nmol/L, IQR 38·6–59·4 vs. 61·8 nmol/L, IQR 40·2–77·8, P = 0·074) and higher vitamin D deficiency prevalence (60% vs. 36%, P = 0·057). After adjusting for age, gender, hypertension, hypercholesterolemia, diabetes, atrial fibrillation, smoking and ischemic heart disease, patients with large artery stroke had lower serum 25-OHD (P = 0·002) and were 3·5 times more likely to have vitamin D deficiency compared to small artery stroke patients (P = 0·022).
This is the first cross-sectional study comparing serum 25-OHD between ischemic stroke etiologies. Our findings may be explained by a stronger relationship between vitamin D deficiency and large artery stroke. Alternatively, small cerebral arteries may be more susceptible to vitamin D deficiency as suggested in a case-control study of healthy female nurses showing a higher risk of small artery stroke among patients with lowest versus highest tertiles of serum 25-OHD, but no associated risk of large artery stroke . Longitudinal studies are needed to better understand the differential relationship between vitamin D deficiency and stroke etiologies. Furthermore, the benefit of vitamin D replacement may differ for large and small artery stroke prevention.