We read with great interest the excellent work by Anderson et al who showed in 41,504 patients derived from a medical record database that a poor vitamin D status is associated with increased cardiovascular risk. We were impressed to see that low 25-hydroxyvitamin D (25[(OH)]D) levels are associated with previous and incident cerebrovascular accidents (CVAs). These findings extend previous observations from smaller studies and deserve particular attention. Evidence for low 25(OH)D levels in patients after stroke is of concern because common musculoskeletal complications of such patients can be partly prevented by vitamin D intake, which significantly decreases falls and fractures and might have beneficial effects on neurologic and cognitive functions. In this context it should be considered that limited mobility with decreased sunlight exposure and malnutrition are frequently observed in patients after stroke and contribute to vitamin D deficiency. Apart from this, the strong association of low 25(OH)D levels with increased CVA incidence suggests that vitamin D therapy could be effective in preventing such events. This remains, however, to be proved in randomized controlled trials but accumulating evidence suggests that vitamin D supplementation might decrease cerebrovascular risk factors such as arterial hypertension. Hence, in our current clinical practice we should consider the established and proposed multiple health benefits of vitamin D supplementation. Moreover, we should bear in mind that patients with previous CVAs are at particularly high risk of vitamin D deficiency itself and vitamin D deficiency-associated diseases including future CVAs. This patient group might therefore particularly benefit from the prevention and treatment of a poor vitamin D status.
References
- 1. Anderson J.L., May H.T., Horne B.D., Bair T.L., Hall N.L., Carlquist J.F., Lappe D.L., and Muhlestein J.B.: Relation of vitamin D deficiency to cardiovascular risk factors, diseases status, and incident events in a general healthcare population. Am J Cardiol 2010; 106: pp. 963-968
- 2. Kilkkinen A., Knekt P., Aro A., Rissanen H., Marniemi J., Heliövaara M., Impivaara O., and Reunanen A.: Vitamin D status and the risk of cardiovascular disease death. Am J Epidemiol 2009; 170: pp. 1032-1039
- 3. Drechsler C., Pilz S., Obermayer-Pietsch B., Verduijn M., Tomaschitz A., Krane V., Espe K., Dekker F., Brandenburg V., März W., Ritz E., and Wanner C.: Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients. Eur Heart J 2010; 31: pp. 2253-2261
- 4. Pilz S., Dobnig H., Fischer J.E., Wellnitz B., Seelhorst U., Boehm B.O., and März W.: Low vitamin D levels predict stroke in patients referred to coronary angiography. Stroke 2008; 39: pp. 2611-2613
- 5. Pilz S., Tomaschitz A., Drechsler C., Zittermann A., Dekker J.M., and März W.: Vitamin D supplementation: a promising approach for the prevention and treatment of strokes. Curr Drug Targets 2010; undefined:
- 6. Souberbielle J.C., Body J.J., Lappe J.M., Plebani M., Shoenfeld Y., Wang T.J., Bischoff-Ferrari H.A., Cavalier E., Ebeling P.R., Fardellone P., Gandini S., Gruson D., Guerin A.P., Heickendorff L., Hollis B.W., Ish-Shalom S., Jean G., von Landenberg P., Largura A., Olsson T., Pierrot-Deseilligny C., Pilz S., Tincani A., Valcour A., and Zittermann A.: Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: recommendations for clinical practice. Autoimmun Rev 2010; 9: pp. 709-715
- 7. Reddy Vanga S., Good M., Howard P.A., and Vacek J.L.: Role of vitamin D in cardiovascular health. Am J Cardiol 2010; 106: pp. 798-805
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
