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Original Investigation |

Vitamin D and Subclinical Cerebrovascular Disease:  The Atherosclerosis Risk in Communities Brain Magnetic Resonance Imaging Study

Erin D. Michos, MD, MHS1,2; Kathryn A. Carson, ScM2,3; Andrea L. C. Schneider, PhD2; Pamela L. Lutsey, PhD, MPH4; Li Xing, MSc5; A. Richey Sharrett, MD, PhD2; Alvaro Alonso, MD, PhD4; Laura H. Coker, PhD6; Myron Gross, PhD4,7; Wendy Post, MD, MS1,2; Thomas H. Mosley, PhD8; Rebecca F. Gottesman, MD, PhD2,9
[+] Author Affiliations
1Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
3Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
4Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
5Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
6Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
7Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
8Department of Medicine, University of Mississippi Medical Center, Jackson
9Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Neurol. 2014;71(7):863-871. doi:10.1001/jamaneurol.2014.755.
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Importance  Vitamin D deficiency has been associated with hypertension, diabetes mellitus, and incident stroke. Little is known about the association between vitamin D and subclinical cerebrovascular disease.

Objective  To examine the relationship of 25-hydroxyvitamin D (25[OH]D) levels with cerebrovascular abnormalities as assessed on brain magnetic resonance imaging (MRI) among participants of the Atherosclerosis Risk in Communities (ARIC) Brain MRI study.

Design, Setting, and Participants  Participants were white and black adults aged 55 to 72 years with no history of clinical stroke who underwent a cerebral MRI at ARIC visit 3 (n = 1622) and a second cerebral MRI approximately 10 years later (n = 888).

Exposures  The 25(OH)D level was measured by mass spectrometry at visit 3, with levels adjusted for calendar month and categorized using race-specific quartiles.

Main Outcomes and Measures  The cross-sectional and prospective associations of 25(OH)D levels with white matter hyperintensities (WMHs) and MRI-defined infarcts were investigated using multivariable regression models.

Results  The mean age of the participants was 62 years, 59.6% were women, and 48.6% were black. Lower 25(OH)D levels were not significantly associated with WMH score of severity, prevalent high-grade WMH score (≥3), or prevalent infarcts in cross-sectional, multivariable-adjusted models (all P > .05). Similarly, no significant prospective associations were found for lower 25(OH)D levels with change in WMH volume, incident high WMH score (≥3), or incident infarcts on the follow-up MRI, which occurred approximately 10 years later.

Conclusions and Relevance  A single measure of 25(OH)D was not cross-sectionally associated with WMH grade or prevalent subclinical infarcts and was not prospectively associated with WMH progression or subclinical brain infarcts seen on serial cerebral MRIs obtained approximately 10 years apart. These findings do not support optimizing vitamin D levels for brain health.

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Figure.
Mean 25-Hydroxyvitamin D (25[OH]D) Levels by Calendar Month and Race

Unadjusted means (diamonds) and SDs (limit lines) of 25(OH)D levels by calendar month and race showing the sinusoidal relationship of 25(OH)D with calendar month. To convert 25(OH)D to nanomoles per liter, multiply by 2.496.

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