Vitamin D and Vulnerable Carotid Plaque
J S McNally1, T M Burton2, B W Aldred3
1From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.) scott.mcnally@hsc.utah.edu.
Insights
Low vitamin D levels are a significant predictor of carotid intraplaque hemorrhage, a marker of vulnerable plaque. This finding highlights the importance of vitamin D in cardiovascular health and stroke risk assessment.
Area of Science:
- Cardiovascular Imaging
- Vascular Biology
- Nutritional Science
Background:
- Carotid intraplaque hemorrhage (IPH) on MR imaging signifies vulnerable plaque and elevated stroke risk.
- The angiotensin system, implicated in IPH, is modulated by vitamin D.
Purpose of the Study:
- To investigate the association between low vitamin D levels and the presence of carotid intraplaque hemorrhage in humans.
Main Methods:
- Cross-sectional study of 65 patients with carotid disease.
- Carotid MR imaging and serum vitamin D level measurements.
- Multivariable Poisson regression and correlation analyses, including histological validation.
Main Results:
- Low vitamin D levels (<30 ng/mL) significantly predicted MR imaging-detected IPH (prevalence ratio = 2.05, P = .03).
- IPH volume correlated positively with plaque thickness and low vitamin D levels.
- Histology confirmed a correlation between IPH area and low vitamin D levels.
Conclusions:
- Low vitamin D levels, alongside plaque thickness, are independent predictors of carotid intraplaque hemorrhage.
- These findings establish a significant link between vitamin D deficiency and carotid plaque vulnerability.
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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