Key result
Low vitamin D is linked to ~2-fold higher prevalence of carotid intraplaque hemorrhage.
Why the study?
The relationship between low vitamin D levels and carotid intraplaque hemorrhage, a marker of vulnerable plaque and stroke risk, was unclear in humans.
Are low vitamin D levels associated with MR imaging-detected carotid intraplaque hemorrhage in patients with carotid disease?
Cross-Sectional (n=65)
Blinded outcome assessment
No
Are low vitamin D levels associated with MR imaging-detected carotid intraplaque hemorrhage in patients with carotid disease?
Relative Risk: 2.05 (95% CI 1.06–3.96)
p-value: p=0.03
Low vitamin D levels are significantly associated with the presence and volume of vulnerable carotid intraplaque hemorrhage, suggesting a potential role in atherosclerosis and stroke risk.
Low vitamin D was associated with carotid intraplaque hemorrhage; leaves open causal role and need for prospective trials.
BACKGROUND AND PURPOSE: MR imaging–detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans. MATERIALS AND METHODS: In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders and local lumen imaging markers were recorded. To determine the association of low vitamin D levels with MR imaging detected intraplaque hemorrhage, we performed multivariable Poisson regression by using generalized estimating equations to account for up to 2 carotid arteries per patient and backward elimination of confounders. MR imaging detected intraplaque hemorrhage volume was also correlated with vitamin D levels and maximum plaque thickness. Thirty-five patients underwent carotid endarterectomy, and histology-detected intraplaque hemorrhage was correlated with vitamin D levels and total plaque area. RESULTS: Low vitamin D levels (<30 ng/mL, prevalence ratio = 2.05, P = .03) were a significant predictor of MR imaging detected intraplaque hemorrhage, along with plaque thickness (prevalence ratio = 1.40, P < .001). MR imaging detected intraplaque hemorrhage volume linearly correlated with plaque thickness (partial r = 0.45, P < .001) and low vitamin D levels (partial r = 0.26, P = .003). Additionally, histology-detected intraplaque hemorrhage area linearly correlated with plaque area (partial r = 0.46, P < .001) and low vitamin D levels (partial r = 0.22, P = .03). The association of intraplaque hemorrhage volume with low vitamin D levels was also higher with ischemic stroke. CONCLUSIONS: Low vitamin D levels and plaque thickness predict carotid intraplaque hemorrhage and outperform lumen markers of vulnerable plaque. This research demonstrates a significant link between low vitamin D levels and carotid intraplaque hemorrhage.
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McNally et al. (2016) conducted a cross-sectional in Carotid disease (n=65). Low vitamin D levels (<30 ng/mL) vs. Normal vitamin D levels (≥30 ng/mL) was evaluated on MR imaging-detected carotid intraplaque hemorrhage (PR 2.05, 95% CI 1.06-3.96, p=0.03). Low vitamin D levels (<30 ng/mL) significantly predicted the presence of MR imaging-detected carotid intraplaque hemorrhage (PR 2.05) in patients with carotid disease.
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