title: Low dietary vitamin D predicts 34-year incident stroke: the Honolulu Heart Program.
abstract: OBJECTIVE
  Vitamin D deficiency has been reported to contribute to the risk of cardiovascular disease, especially stroke. We examined the relationship between dietary vitamin D intake and 34-year incident stroke.
  
  
  METHODS
  The Honolulu Heart Program is a prospective population-based cohort study of 8006 Japanese-American men in Hawaii who were 45 to 68 years old at the baseline examination in 1965 to 1968. Dietary vitamin D intake was calculated using the Nutritionist IV Version 3 software from a 24-hour dietary recall. Subjects with prevalent stroke were excluded, leaving 7385 men followed through 1999 for incident stroke. Subjects were divided into quartiles of dietary vitamin D for analyses.
  
  
  RESULTS
  During 34 years of follow-up, 960 subjects developed stroke. Age-adjusted rates of incident stroke were significantly higher in the lowest dietary vitamin D quartile compared with the highest (all stroke: 6.38 versus 5.14 per 1000 person-years follow-up, P=0.030; thromboembolic stroke: 4.36 versus 3.30, P=0.033). Using Cox regression, adjusting for age, total kilocalories, body mass index, hypertension, diabetes mellitus, pack-years smoking, physical activity index, serum cholesterol, and alcohol intake, those in the lowest quartile had a significantly increased risk of incident stroke (all stroke hazard ratio, 1.22; 95% CI, 1.01-1.47; P=0.038; thromboembolic stroke hazard ratio, 1.27; 95% CI, 1.01-1.59; P=0.044) with the highest as the reference. We found no significant associations between dietary vitamin D and hemorrhagic stroke.
  
  
  CONCLUSIONS
  Low dietary vitamin D intake was an independent risk factor for 34-year incidence of all stroke and thromboembolic stroke in Japanese-American men. Additional research is needed on vitamin D supplementation to prevent stroke.
authors.affiliation: The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96817, USA. gotarokojima@yahoo.co.jp
authors.forename: Gotaro
authors.initials: G
authors.lastname: Kojima
authors.forename: Christina
authors.initials: C
authors.lastname: Bell
authors.forename: Robert D
authors.initials: RD
authors.lastname: Abbott
authors.forename: Lenore
authors.initials: L
authors.lastname: Launer
authors.forename: Randi
authors.initials: R
authors.lastname: Chen
authors.forename: Heather
authors.initials: H
authors.lastname: Motonaga
authors.forename: G Webster
authors.initials: GW
authors.lastname: Ross
authors.forename: J David
authors.initials: JD
authors.lastname: Curb
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001213:Asian / Q000706:statistics & numerical data; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology; D015331:Cohort Studies; D004032:Diet; D004034:Diet Surveys; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013923:Thromboembolism / Q000150:complications / Q000453:epidemiology; D014807:Vitamin D
chemical_list: D014807:Vitamin D