Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China; 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 Cardiology, Peking University First Hospital, Beijing, China.
Nutrition. 2022 Jul-Aug;99-100:111627. doi: 10.1016/j.nut.2022.111627. Epub 2022 Feb 5.
The aim of this study was to investigate the relationship between 25-hydroxyvitamin D (25[OH]D) and ischemic stroke and its potential modifying factors in rural Chinese adults.
This nested case-control study was drawn from the H-type Hypertension and Stroke Prevention and Control Project, a community-based, prospective, observational study. Plasma 25(OH)D was measured by liquid chromatography with tandem quadrupole mass spectrometry. All stroke records came from the Chinese Center for Disease Control and Prevention. Multiple logistic regression models were used to evaluate the association between 25(OH)D and risk of ischemic stroke.
We included 1079 participants with ischemic stroke and 1079 matched controls. Due to a non-linear relationship, the analyses were stratified by 25(OH)D. For those with 25(OH)D < 20 ng/mL, there was a 15% reduction in the risk of ischemic stroke for each SD increment in 25(OH)D (odds ratio, 0.85; 95% confidence interval, 0.73-0.99). Compared with the lowest-tertile group, the risk of ischemic stroke decreased by 39% (odds ratio, 0.61; 95% confidence interval, 0.41-0.89) in the highest-tertile group. Furthermore, two effect modifiers were identified: diabetes and homocysteine level. Although participants with 25(OH)D ≥ 20 ng/mL had the lowest risk of ischemic stroke overall, there was no dose-response association within that range.
An inverse dose-response association between 25(OH)D and incident risk of ischemic stroke in rural Chinese adults was only observed in those with 25(OH)D < 20 ng/mL, along with two effect modifiers. Higher levels of 25(OH)D did not confer additional benefit.
本研究旨在探讨农村成年人中 25-羟维生素 D（25[OH]D）与缺血性卒中的关系及其潜在的调节因素。
本巢式病例对照研究来自 H 型高血压与脑卒中防控的前瞻性、观察性社区研究。采用液相色谱-串联四级杆质谱法测定血浆 25(OH)D。所有卒中记录均来自中国疾病预防控制中心。采用多因素 logistic 回归模型评估 25(OH)D 与缺血性卒中风险之间的关系。
共纳入 1079 例缺血性卒中患者和 1079 例匹配对照。由于存在非线性关系，故对 25(OH)D 进行分层分析。对于 25(OH)D<20ng/mL 的人群，25(OH)D 每增加 1 个标准差，缺血性卒中风险降低 15%（比值比，0.85；95%置信区间，0.73-0.99）。与最低三分位组相比，最高三分位组缺血性卒中风险降低 39%（比值比，0.61；95%置信区间，0.41-0.89）。此外，还鉴定出两个效应修饰因子：糖尿病和同型半胱氨酸水平。尽管 25(OH)D≥20ng/mL 的患者总体上缺血性卒中风险最低，但在此范围内没有剂量-反应关系。
在农村成年人中，25(OH)D 与缺血性卒中风险呈负相关，但仅在 25(OH)D<20ng/mL 的人群中观察到这种关联，且存在两个效应修饰因子。更高水平的 25(OH)D 并未带来额外获益。
