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Low Vitamin D Status and Post-Stroke Depression; Falls; and Functional Recovery in Older Adults with Nonvalvular Atrial Fibrillation–Associated Ischemic Stroke
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DOI：10.2147/cia.s607805.png)
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Abstract
En 中文
Li Li,1,2 Juping Wang,1 Rongrong Kang,1 Tianqi Zhang,1 Zhongsha Chen1 1Department of Neurology, Jincheng General Hospital, Jincheng, Shanxi, 048006, People’s Republic of China; 2Department of Neurology, Tianjin Huanhu Hospital, Tianjin Neurological Central Hospital, Tianjin, 300000, People’s Republic of China Correspondence: Li Li, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Neurological Central Hospital, No. 6 Jizhao Road, Jinnan District, Tianjin, 300350, People’s Republic of China, Email lili_1982@126.com Background: Older adults with atrial fibrillation (AF)–associated acute ischemic stroke are prone to disability, depressive symptoms, and falls; the prognostic value of vitamin D status is uncertain. Methods: We conducted a single-center prospective cohort study of patients aged ≥ 65 years with ECG-confirmed AF and imaging-confirmed acute ischemic stroke at a tertiary hospital in China (January 2022–August 2024). Serum 25-hydroxyvitamin D [25(OH)D] within 48 hours was modeled per 10 ng/mL decrement and as < 20 vs ≥ 20 ng/mL. Outcomes were 3-month modified Rankin Scale (mRS) shift, Barthel Index (BI), and PHQ-9 ≥ 10, plus 12-month time to first fall (death as a competing event) and total falls rate. Models adjusted for prespecified baseline confounders. Results: Among 802 participants, median age was 76.2 years (IQR, 71.6– 80.6); 60.7% had 25(OH)D < 20 ng/mL. Three-month mRS/BI, 3-month PHQ-9, and falls follow-up data were available for 776 (96.8%), 762 (95.0%), and 742 (92.5%) participants, respectively. Each 10 ng/mL lower 25(OH)D was associated with worse 3-month mRS shift (common OR 1.17, 95% CI 1.05– 1.31) and lower BI (β − 3.9, 95% CI − 6.2 to − 1.6). Depressive symptoms occurred in 16.8% and were more common with 25(OH)D < 20 ng/mL (OR 1.54, 95% CI 1.07– 2.22). Among 742 with falls follow-up, low 25(OH)D predicted first fall (HR 1.29, 95% CI 1.07– 1.55) and a higher recurrent falls rate (IRR 1.33, 95% CI 1.10– 1.61). Conclusion: Lower baseline 25(OH)D was consistently associated with poorer functional recovery, greater depressive symptom burden, and higher fall risk and recurrence, supporting 25(OH)D as a pragmatic prognostic marker; multicenter validation and targeted trials are warranted. Keywords: 25(OH)D, atrial fibrillation, acute ischemic stroke, post-stroke depression, falls
Keywords:
25(OH)D
atrial fibrillation
acute ischemic stroke
post-stroke depression
falls
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