PT  - JOURNAL ARTICLE
AU  - J.S. McNally
AU  - T.M. Burton
AU  - B.W. Aldred
AU  - S.-E. Kim
AU  - M.S. McLaughlin
AU  - L.B. Eisenmenger
AU  - G.J. Stoddard
AU  - J.J. Majersik
AU  - D.V. Miller
AU  - G.S. Treiman
AU  - D.L. Parker
TI  - Vitamin D and Vulnerable Carotid Plaque
AID  - 10.3174/ajnr.A4849
DP  - 2016 Jun 16
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2016/06/16/ajnr.A4849.short
4100  - http://www.ajnr.org/content/early/2016/06/16/ajnr.A4849.full
AB  - 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.AbbreviationsAT1Rangiotensin II type 1 receptorIPHintraplaque hemorrhageNADPHnicotinamide adenine dinucleotide phosphatePRprevalence ratio