Association between serum 25-hydroxyvitamin d and early recurrent ischemic stroke

Aim: Vitamin D deficiency has been reported as a new risk factor for ischemic stroke in recent years. However, the pathophysiologicalmechanisms between recurrent ischemic stroke and decreased 25-hydroxyvitamin D [25(OH) D] are not clear. The aim of this studyis to examine the relationship between initial vitamin D levels and early recurrent stroke in patients presenting with acute ischemicstroke (AIS).Material and Methods: Four hundreds and ten consecutive patients who were followed-up with AIS diagnosis were included in thestudy. Risk factors for ischemic stroke were questioned and biochemical and cardiac examinations of the patients were performed.Simultaneously, the National Institutes of Health Stroke Scale (NIHSS) was calculated. Patients who had recurrent ischemic strokeobtained retrospectively were from the hospital registry system in last three month. The patients were divided into two groups asthose who had recurrent stroke and who did not.Results: A total of 410 patients, 187 of which were female (45.6%) and 223 of which were male (54.4%) with a mean age of 68.12 ±12.63 (29-99) were included in the study. Early recurrent ischemic stroke was detected in 48 (11.7%) patients in the follow-up. Thesystolic blood pressure and diastolic blood pressures at the time of first consultation were higher in the recurrent ischemic strokegroup compared to the non-recurrent ischemic stroke group (p

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1. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990- 2010: findings from the Global Burden of Disease Study 2010. Lancet 2014;383:245-54.
2. Wang W, Jiang B, Sun H, et al. Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults. Circulation 2017;135:759-71.
3. Zhang Q, Ding H, Yan J, et al. Plasma tissue kallikrein level is negatively associated with incident and recurrent stroke: a multicenter caseecontrol study in China. Ann Neurol 2011;70:265-73.
4. Wang A, Wu L, Wang X, et al. Effect of recurrent stroke on poor functional outcome in transient ischemic attack or minor stroke. Int J Stroke 2016;11:80-2.
5. Kojima G, Bell C, Abbott RD, et al. Low dietary vitamin D predicts 34-year incident stroke: The Honolulu Heart Program. Stroke 2012;43:2163-7.
6. Pilz, S, Dobnig H, Fischer JE, et al. Low vitamin d levels predict stroke in patients referred to coronary angiography. Stroke 2008;39:2611-3.
7. Buell JS, Dawson-Hughes B, Scott TM, et al. 25-Hydroxyvitamin D, dementia, and cerebrovascular pathology in elders receiving home services. Neurology 2010;74:18-26.
8. Bouillon R, Carmeliet G, Verlinden L, et al. Vitamin D and human health: Lessons from vitamin D receptor null mice. Endocr Rev 2008;29:726-76.
9. Guillot X, Semerano L, Saidenberg-Kermanac’h N, et al. Vitamin D and inflammation. Jt. Bone Spine 2010;77:552-7.
10. Brøndum-Jacobsen P, Nordestgaard BG, Schnohr P, et al. 25- Hydroxyvitamin D and symptomatic ischemic stroke: an original study and meta-analysis. Ann Neurol 2013;73:38-47.
11. Adams Jr HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993;24:35-41.
12. Bamford J, Sandercock P, Dennis M, et al. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521-6.
13. Kilkkinen A, Knekt P, Aro A, et al. Vitamin D status and the risk of cardiovascular disease death. Am J Epidemiol 2009;170:1032-9.
14. Schierbeck LL, Rejnmark L, Tofteng CL, et al. Vitamin D deficiency in postmenopausal, healthy women predicts increased cardiovascular events: A 16-year follow-up study. Eur. J. Endocrinol 2012;167:553-60.
15. Alfieri DF, Lehmann MF, Oliveira SR, et al. Vitamin D deficiency is associated with acute ischemic stroke, C-reactive protein, and short-term outcome. Metab Brain Dis 2017;32:493-502.
16. Leung RY, Han Y, Sing, CW, et al. Serum 25-hydroxyvitamin D and the risk of stroke in Hong Kong Chinese. Thromb Haemost 2017;117:158-63.
17. Li YC, Qiao G, Uskokovic M, et al. Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. J Steroid Biochem Mol Biol 2004;89-90:387-92.
18. Sun Q, Pan A, Hu FB, et al. 25-Hydroxyvitamin D levels and the risk of stroke: a prospective study and metaanalysis. Stroke 2012;43:1470-7.
19. Zhou R, Wang M, Huang H, et al. Lower Vitamin D Status Is Associated with an Increased Risk of Ischemic Stroke: A Systematic Review and MetaAnalysis. Nutrients 2018;10:277.
20. Huang H, Zheng T, Wang S, et al. Serum 25-hydroxyvitamin D predicts early recurrent stroke in ischemic stroke patients. Nutr Metab Cardiovasc Dis 2016;26:908-14.
21. Ford JA, MacLennan GS, Avenell A, et al. Cardiovascular disease and vitamin D supplementation: Trial analysis, systematic review, and meta-analysis. Am J Clin Nutr 2014;100:746-55.
22. Welles CC, Whooley MA, Karumanchi SA, et al. Vitamin D deficiency and cardiovascular events in patients with coronary heart disease: data from the Heart and Soul study. Am J Epidemiol 2014;179:1279-87.
23. Fitzpatrick LA, Bilezikian JP, Silverberg SJ. Parathyroid hormone and the cardiovascular system. Curr Osteoporos Rep 2008;6:77-83.
24. Hagström E, Hellman P, Larsson TE, et al. Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation 2009 Jun 2;119:2765-71.
25. Sato Y, Kaji M, Metoki N, et al. “Does compensatory hyperparathyroidism predispose to ischemic stroke?” Neurology 2003;60:626-9
26. Celik G, Dogan A, Dener S, et al. Parathyroid Hormone Levels in the Prediction of Ischemic Stroke Risk. Dis Markers 2017;2017:4343171
27. Howard G, Kissela BM, Kleindorfer DO, et al. Differences in the role of black race and stroke risk factors for first vs recurrent stroke. Neurology 2016;86:637-42.
28. Aarnio K, Haapaniemi E, Melkas S, et al. Long-term mortality after first-ever and recurrent stroke in young adults. Stroke 2014;45:2670-6.
29. Giang KW, Björck L, Ståhl CH, et al. Trends in risk of recurrence after the first ischemic stroke in adults younger than 55 years of age in Sweden. Int J Stroke 2016;11:52-61.
30. Wang Y, Xu J, Zhao X, et al. Association of hypertension with stroke recurrence depends on ischemic stroke subtype. Stroke 2013;44:1232-7.
31. Hong KS. Blood Pressure Management for Stroke Prevention and in Acute Stroke. J Stroke 2017;19:152- 65.
32. Chang Y, Kim J, Kim YJ, et al. Inter-arm Blood Pressure Difference is Associated with Recurrent Stroke in Noncardioembolic Stroke Patients. Sci Rep 2019;9:12758.
33. Lisheng L, Zengwu W, Yuging Z, et al. Blood pressure reduction for the secondary prevention of stroke: a Chinese trial and a systematic review of the litera¬ture. Hypertens Res 2009;32:1032-40.
34. Katsanos AH, Filippatou A, Manios E, et al. Blood pressure reduction and secondary stroke prevention: a systematic review and metaregression analysis of randomized clinical trials. Hypertension 2017;69:171- 9.