Letter Regarding Article, Vitamin D deficiency is associated with subclinical carotid atherosclerosis: the Northern Manhattan study.
Letter Regarding Article, Vitamin D deficiency is associated with subclinical carotid atherosclerosis: the Northern Manhattan study.
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关于文章的信函：维生素 D 缺乏与亚临床颈动脉粥样硬化有关：曼哈顿北部研究。
DOI：
10.1161/strokeaha.111.634154
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发表时间：
2011
期刊：
影响因子：
8.3
通讯作者：
et al.
中科院分区：
文献类型：
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作者：
Kazushi Tsuda;et al.
我们怀着极大的兴趣阅读了Carrelli等人的一篇文章，该文章涉及自由生活、无中风、多种族的城市队列中血清维生素D水平与颈动脉粥样硬化之间的关系。他们的研究结果表明，血磷和钙磷乘积与亚临床颈动脉粥样硬化的负担更大相关。在那些有颈动脉斑块的人中，作者发现25-羟基维生素D水平较低与颈动脉斑块较厚和颈动脉内中膜厚度较高有关。作者提出，维生素D缺乏与颈动脉血管异常有很强的相关性，可以预测心肌梗死和中风的发展。有证据表明，低骨密度(BMD)与中风有显著的关联。Jörgensen等人提出，低骨密度可能预示女性首次中风。在我们之前公布的一项研究中，我们调查了女性骨密度与高血压的关系。采用双能X线骨密度仪，发现老年高血压妇女腰椎骨密度明显低于血压正常的老年妇女。3老年女性骨密度与收缩压呈负相关，提示高血压可能与老年女性骨密度降低有关。一些研究表明，高血压与钙代谢异常有关，如肾脏钙流失增加，甲状旁腺继发性激活，维生素D缺乏。研究表明，女性24小时钙排泄量越大，骨密度越低。3老年脑卒中患者骨密度与血清维生素D水平呈负相关。4最近，Pilz et AL5证明，低水平的25-羟基维生素D和1，25-羟基维生素D是致命性中风的独立决定因素，在既往有脑血管疾病病史的患者中降低。此外，他们提出，补充维生素D可能是预防中风的一种有前途的方法。在此背景下，可以推测，在高血压和骨密度降低的受试者中，钙代谢的紊乱可能更加明显。因此，我们想知道在Carrelli等人的研究中，血清维生素D水平是否可能与人群中血压或骨密度的大小有关。更准确地评估维生素D缺乏、骨密度丢失和高血压之间的关系以及它们对中风发病率的影响将是很重要的。
We read with great interest the article by Carrelli et al1 dealing with the relationship between serum vitamin D levels and carotid atherosclerosis in a free-living, stroke-free, multiethnic, urban cohort. The results of their study demonstrated that serum phosphorus and calcium–phosphorus product were associated with a greater burden of subclinical carotid atherosclerosis. Among those with carotid plaque, the authors found that lower 25-hydroxyvitamin D levels were associated with thicker plaque and higher intima-media thickness of the carotid artery. The authors proposed the strong relationship between vitamin D deficiency and carotid vascular abnormalities that predicts the development of myocardial infarction and stroke. Evidence indicates that there were significant associations between low bone mineral density (BMD) and stroke. Jörgensen et al2 proposed that low BMD might predict first stroke in women. In a study we presented previously, a relationship between BMD and hypertension was investigated in women. Using the dual-energy X-ray absorptiometric method, we demonstrated that BMD in lumbar spine was significantly decreased in elderly hypertensive women compared with elderly normotensive women. 3 In addition, BMD was inversely correlated with systolic blood pressure, suggesting that high blood pressure might be associated with the decrease in BMD in elderly women. Several studies have shown that hypertension is related to abnormalities of the calcium metabolism, such as increased calcium losses from the kidney, secondary activation of parathyroid glands, and vitamin D deficiency. It was demonstrated that the greater the 24-hour calcium excretion was, the lower the BMD was in women. 3 It was also shown that BMD correlated negatively with serum vitamin D levels in elderly poststroke patients. 4 Recently, Pilz et al5 demonstrated that low levels of 25-hydroxyvitamin D and 1, 25-hydroxyvitamin D were independent determinants of fatal stroke and were reduced in patients with a history of previous cerebrovascular diseases. Furthermore, they proposed that vitamin D supplementation might be a promising approach in the prevention of stroke. In this context, it can be speculated that in subjects with hypertension and lowered BMD, the disturbances in the calcium metabolism might be more pronounced. Therefore, we would like to know whether serum vitamin D levels might be related to the magnitudes of blood pressure or BMD in the populations in the study of Carrelli et al. It would be important to assess more precisely the relationships among vitamin D deficiency, BMD losses, and hypertension, and their contribution to stroke incidence.