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. 2025 Jan 13;24(1):5.
doi: 10.1186/s12937-025-01076-x.

Combined 25-hydroxyvitamin D concentrations and physical activity on mortality in US stroke survivors: findings from the NHANES

Junqi Liao #  1   2 , Jingyi Chen #  1   2 , Huimin Wu  1   2 , Qing Zhu  1   2 , Xiaogang Tang  1   2 , Li Li  1   2 , Aimei Zhang  1   2 , Peiyi Mo  1   2 , Yan Liu  1   2 , Xinyi Yang  1   2 , Yang Han  3 , Zhaoyao Chen  1   2 , Wenlei Li  4   5 , Yuan Zhu  6   7 , Minghua Wu  8   9   10
Affiliations

Combined 25-hydroxyvitamin D concentrations and physical activity on mortality in US stroke survivors: findings from the NHANES

Junqi Liao et al. Nutr J. .

Abstract

Background: 25-hydroxyvitamin D [25(OH)D] concentrations and physical activity (PA) are linked and both are associated with changes in mortality. We examined the association of 25(OH)D and PA with all-cause or cause-specific mortality risk in stroke survivors.

Methods: The analysis included 677 stroke survivors from National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2017-2018. Independent and joint associations of 25(OH)D, PA and mortality among stroke survivors were analyzed using weighted Cox regression.

Results: We identified 133 all-cause deaths [major adverse cardiovascular events (MACE), 34; non-MACE, 79] with a median follow-up of 5.8 years (interquartile, 2.8-8.9 years). In a range of adjusted models, high 25(OH)D was observed with lower all-cause mortality compared to low 25(OH)D (HR, 0.376; 95% CI, 0.233-0.607) and non-MACE (HR, 0.265; 95% CI, 0.143-0.490) mortality was consistently associated. At the same time, compared with no PA, PA was associated with a lower all-cause (HR, 0.280; 95%CI, 0.107-0.733) and non-MACE (HR, 0.266; 95%CI, 0.087-0.810) was associated with a lower risk of death. In addition, pooled analyses showed that stroke survivors with high 25(OH)D and PA had the lowest risk of all-cause death (HR, 0.132; 95%CI, 0.038-0.460) and non-MACE (HR, 0.092; 95%CI, 0.023-0.363), there is an additive interaction between 25(OH)D and PA in non-MACE.

Conclusion: In conclusion, this study found that combining high 25(OH)D levels and PA showed an enhanced protective effect which demonstrated a synergistic effect between them in reducing mortality among stroke survivors. These findings provide new ideas and possibilities for the prevention and treatment of cardiovascular and cerebrovascular diseases, offering a reference for development of clinical practice guidelines in the future.

Keywords: 25-hydroxyvitamin D; Mortality; Physical activity; Stroke survivors.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for subject selection
Fig. 2
Fig. 2
Association of 25(OH)D levels with all-cause mortality among US stroke survivors by Restricted Cubic Splines. HR, Hazard ratios
Fig. 3
Fig. 3
Joint association of 25(OH)D levels and PA status with mortality among US stroke survivors. A, all-cause mortality; B, non-MACE
Fig. 4
Fig. 4
Kaplan-Meier curves for the relationship between 25(OH)D levels, PA status and all-cause mortality and non-MACE. A, all-cause mortality; B, non-MACE
Fig. 5
Fig. 5
Stratified analysis of association between 25(OH)D levels and PA status and all-cause mortality. A, 25(OH)D levels and all-cause mortality; B, PA status and all-cause mortality. Models were adjusted for age, sex, race, body mass index, education, history of smoking and drinking, and health factors (hypertension, dyslipidemia, diabetes, CVD)
See this image and copyright information in PMC

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