25-Hydroxy vitamin D level is associated with total MRI burden of cerebral small vessel disease in ischemic stroke patients

Background: Decreased 25-hydroxyvitamin D [25(OH)D] has been reported to be related to increased risk of cerebrovascular disease. We aimed to investigate whether an association exists between 25(OH)D levels and cerebral small vessel disease (cSVD). Method: Patients with first-ever minor ischemic stroke or transient ischemic attack were recruited prospectively during Jan 2017 to December 2017. Serum 25(OH)D levels were measured at admission in all patients. Magnetic resonance imaging (MRI) was performed to determine the presence of cSVD, including silent lacunar infarcts (SLIs), white matter lesions (WMLs), cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVs). The severity of cSVD was evaluated by total MRI cSVD burden, an ordinal score from 0 to 4. The association between the baseline 25(OH)D level and cSVD was analyzed by multiple logistic regression models. Results: Of 234 patients included, the median 25(OH)D level was 39.2 nmol/L. The proportions of patients with 0 to 4 cSVD features were 8.5%, 29.1%, 42.3%, 16.2%, and 3.8%, respectively. After adjusting for potential confounders, multiple logistic regression analysis demonstrated that patients with 25(OH)D level in its first quartile, compared with those in its fourth quartile, were more likely to have severe WMLs [odds ratio (OR), 3.31; 95% confidence interval (CI) 1.74-9.67; p = .004], severe EPVs (OR, 2.35; 95% CI 1.11-6.02, p = .046] and increasing total MRI cSVD burden (OR, 3.00; 95% CI 1.36-6.53, p = .006). Conclusions: Lower levels of 25(OH)D are associated with greater total MRI cSVD burden in ischemic stroke patients.