Wei Yaping, Xu Benjamin, Wang Zhuo, Zhou Ziyi, Liu Lishun, Lin Tengfei, Song Yun, Li Jianping, Zhang Yan, Huo Yong, Mao Guangyun, Wang Binyan, Tang Genfu, Qin Xianhui, Zhang Hao, Wang Xiaobin, Guo Huiyuan, Xu Xiping
Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
J Nutr. 2022 Jan 11;152(1):246-254. doi: 10.1093/jn/nxab339.
Associations between vitamin D and stroke remain inconsistent. One major risk factor for stroke is high blood glucose, but the role it plays in this association is not well studied.
We aimed to evaluate the individual association between plasma 25-hydroxyvitamin D [25(OH)D] and risk of first stroke stratified by fasting blood glucose (FBG), and the joint associations between plasma 25(OH)D, glycemic status, and first stroke in hypertensive adults.
This study was a nested, case-control design utilizing data from the China Stroke Primary Prevention Trial (CSPPT). This analysis included 591 first stroke cases (of which 475 were ischemic stroke, 114 were hemorrhagic stroke, and 2 were uncertain type) and 591 matched controls. The age range of the study population was 45-75 y. The normal FBG (NFG) group had FBG <5.6 mmol/L, and the impaired FBG (IFG) group had FBG ≥5.6 mmol/L and <7.0 mmol/L. Diabetes was defined as participants with FBG ≥7 mmol/L or who were receiving treatment with hypoglycemic agents. ORs (95% CIs) were calculated using unconditional logistic regression models.
Multivariable adjusted models revealed an inverse association between quartiles of 25(OH)D and risk of first stroke among participants with NFG, but the opposite trend was observed for those with IFG or diabetes. The largest ORs (>2) were observed among patients with diabetes, compared with the reference group of NFG and high 25(OH)D. Those with NFG and low 25(OH)D (OR = 1.73, 95% CI: 1.22 to 2.44) or those with IFG and high 25(OH)D (OR = 1.74, 95% CI: 1.14 to 2.67) both had a higher risk of total stroke. There was a significant interaction between 25(OH)D and a combined group of IFG and diabetes (P = 0.001). Similar results were observed for ischemic stroke.
In a hypertensive population, the relation between plasma 25(OH)D and risk of first stroke was significantly modified by FBG. This trial was registered at https://www.clinicaltrials.gov as NCT00794885.
维生素D与中风之间的关联仍不一致。中风的一个主要危险因素是高血糖，但其在这种关联中所起的作用尚未得到充分研究。
我们旨在评估血浆25-羟基维生素D[25(OH)D]与首次中风风险之间的个体关联，并按空腹血糖(FBG)进行分层，同时评估血浆25(OH)D、血糖状态与高血压成年人首次中风之间的联合关联。
本研究采用巢式病例对照设计，利用中国脑卒中一级预防试验(CSPPT)的数据。该分析纳入了591例首次中风病例(其中475例为缺血性中风，114例为出血性中风，2例为不确定类型)和591例匹配对照。研究人群的年龄范围为45-75岁。正常空腹血糖(NFG)组的空腹血糖<5.6 mmol/L，空腹血糖受损(IFG)组的空腹血糖≥5.6 mmol/L且<7.0 mmol/L。糖尿病定义为空腹血糖≥7 mmol/L或正在接受降糖药物治疗的参与者。使用无条件逻辑回归模型计算比值比(ORs)(95%置信区间)。
多变量调整模型显示，在NFG参与者中，25(OH)D四分位数与首次中风风险呈负相关，但在IFG或糖尿病患者中观察到相反的趋势。与NFG和高25(OH)D的参照组相比，糖尿病患者的OR值最大(>2)。NFG且25(OH)D水平低的患者(OR = 1.73，95%置信区间：1.22至2.44)或IFG且25(OH)D水平高的患者(OR = 1.74，95%置信区间：1.14至2.67)发生全中风的风险均较高。25(OH)D与IFG和糖尿病的联合组之间存在显著交互作用(P = 0.001)。缺血性中风也观察到类似结果。
在高血压人群中，FBG显著改变了血浆25(OH)D与首次中风风险之间的关系。该试验已在https://www.clinicaltrials.gov注册，注册号为NCT00794885。
