Letter to the Editor Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited.
Letter by Tsuda Regarding Article, “Serum Alkaline Phosphatase and Phosphate in Cerebral Atherosclerosis and Functional Outcomes After Cerebral Infarction”
To the Editor: We read with great interest the article by Kim et al1 dealing with the relationship between serum levels of alkaline phosphatase (ALP)/phosphate and both cerebral atherosclerosis and functional outcomes in patients with acute cerebral infarction. The results of their study demonstrated that ALP levels were not associated with cerebral atherosclerosis but were an independent prognostic factor for long-term functional outcomes after acute cerebral infarction. However, it was shown that phosphate was associated with neither cerebral atherosclerosis nor functional outcomes. The authors proposed that although a relationship between ALP/ phosphate levels and cerebral atherosclerosis was not observed, patients with elevated ALP levels had poor outcomes after acute cerebral infarction. Evidence indicates that there were significant associations between low bone mineral density (BMD) and stroke. Jørgensen et al2 proposed that low BMD might predict first stroke in women. In a study presented previously, we showed that BMD was correlated inversely with urinary calcium excretion and systolic blood pressure in women.3 It can be speculated that in subjects with hypertension and lowered BMD, the disturbances in the calcium metabolism might be more pronounced. Recently, Carrelli et al4 demonstrated that lower serum 2 5-hydroxyvitamin D levels were associated with thicker plaque and higher intima- media thickness of the carotid artery, suggesting that vitamin D deficiency might predict the development of cerebral atherosclerosis and stroke. Pilz et al5 also reported that low serum levels of 25-hydroxyvitamin D and 1, 25-hydroxyvitamin D were independent determinants of fatal stroke and proposed
that vitamin D supplementation might be a promising approach in the prevention of stroke.5 Because both ALP and phosphate might strongly be related to the calcium and bone metabolism, we would like to know whether levels of ALP/phosphate might be correlated with the changes in BMD and serum vitamin D levels in the populations in the study of Dr Kim et al.1 It would be important to assess more precisely the relationships among levels of ALP/phosphate, BMD losses and vitamin D deficiency, and their predictive values for both cerebral atherosclerosis and stroke prognosis.
Disclosures None.
Kazushi Tsuda, MD, FAHA Cardiovascular Medicine, Cardiovascular and Metabolic Research Center Kansai University of Health Sciences Osaka, Japan 1. Kim J, Song TJ, Song D, Lee HS, Nam CM, Nam HS, et al. Serum alkaline phosphatase and phosphate in cerebral atherosclerosis and functional outcomes after cerebral infarction. Stroke. 2013;44:3547–3549. 2. Jørgensen L, Engstad T, Jacobsen BK. Bone mineral density in acute stroke patients: low bone mineral density may predict first stroke in women. Stroke. 2001;32:47–51. 3. Tsuda K, Nishio I, Masuyama Y. Bone mineral density in women with essential hypertension. Am J Hypertens. 2001;14(7 pt 1):704–707. 4. Carrelli AL, Walker MD, Lowe H, McMahon DJ, Rundek T, Sacco RL, et al. Vitamin D deficiency is associated with subclinical carotid atherosclerosis: the Northern Manhattan study. Stroke. 2011;42:2240–2245. 5. Pilz S, Dobnig H, Fischer JE, Wellnitz B, Seelhorst U, Boehm BO, et al. Low vitamin D levels predict stroke in patients referred to coronary angiography. Stroke. 2008;39:2611–2613.
(Stroke. 2014;45:e46.) © 2014 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org
DOI: 10.1161/STROKEAHA.113.004276
Downloaded from http://stroke.ahajournals.org/ at UNIV e46 OF ULSTER AT COLERAINE on March 15, 2015
Letter by Tsuda Regarding Article, ''Serum Alkaline Phosphatase and Phosphate in Cerebral Atherosclerosis and Functional Outcomes After Cerebral Infarction'' Kazushi Tsuda Stroke. 2014;45:e46; originally published online January 21, 2014; doi: 10.1161/STROKEAHA.113.004276 Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2014 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/45/3/e46
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Stroke can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Stroke is online at: http://stroke.ahajournals.org//subscriptions/
Downloaded from http://stroke.ahajournals.org/ at UNIV OF ULSTER AT COLERAINE on March 15, 2015
Letter by Tsuda Regarding Article, “Serum Alkaline Phosphatase and Phosphate in Cerebral Atherosclerosis and Functional Outcomes After Cerebral Infarction”
To the Editor: We read with great interest the article by Kim et al1 dealing with the relationship between serum levels of alkaline phosphatase (ALP)/phosphate and both cerebral atherosclerosis and functional outcomes in patients with acute cerebral infarction. The results of their study demonstrated that ALP levels were not associated with cerebral atherosclerosis but were an independent prognostic factor for long-term functional outcomes after acute cerebral infarction. However, it was shown that phosphate was associated with neither cerebral atherosclerosis nor functional outcomes. The authors proposed that although a relationship between ALP/ phosphate levels and cerebral atherosclerosis was not observed, patients with elevated ALP levels had poor outcomes after acute cerebral infarction. Evidence indicates that there were significant associations between low bone mineral density (BMD) and stroke. Jørgensen et al2 proposed that low BMD might predict first stroke in women. In a study presented previously, we showed that BMD was correlated inversely with urinary calcium excretion and systolic blood pressure in women.3 It can be speculated that in subjects with hypertension and lowered BMD, the disturbances in the calcium metabolism might be more pronounced. Recently, Carrelli et al4 demonstrated that lower serum 2 5-hydroxyvitamin D levels were associated with thicker plaque and higher intima- media thickness of the carotid artery, suggesting that vitamin D deficiency might predict the development of cerebral atherosclerosis and stroke. Pilz et al5 also reported that low serum levels of 25-hydroxyvitamin D and 1, 25-hydroxyvitamin D were independent determinants of fatal stroke and proposed
that vitamin D supplementation might be a promising approach in the prevention of stroke.5 Because both ALP and phosphate might strongly be related to the calcium and bone metabolism, we would like to know whether levels of ALP/phosphate might be correlated with the changes in BMD and serum vitamin D levels in the populations in the study of Dr Kim et al.1 It would be important to assess more precisely the relationships among levels of ALP/phosphate, BMD losses and vitamin D deficiency, and their predictive values for both cerebral atherosclerosis and stroke prognosis.
Disclosures None.
Kazushi Tsuda, MD, FAHA Cardiovascular Medicine, Cardiovascular and Metabolic Research Center Kansai University of Health Sciences Osaka, Japan 1. Kim J, Song TJ, Song D, Lee HS, Nam CM, Nam HS, et al. Serum alkaline phosphatase and phosphate in cerebral atherosclerosis and functional outcomes after cerebral infarction. Stroke. 2013;44:3547–3549. 2. Jørgensen L, Engstad T, Jacobsen BK. Bone mineral density in acute stroke patients: low bone mineral density may predict first stroke in women. Stroke. 2001;32:47–51. 3. Tsuda K, Nishio I, Masuyama Y. Bone mineral density in women with essential hypertension. Am J Hypertens. 2001;14(7 pt 1):704–707. 4. Carrelli AL, Walker MD, Lowe H, McMahon DJ, Rundek T, Sacco RL, et al. Vitamin D deficiency is associated with subclinical carotid atherosclerosis: the Northern Manhattan study. Stroke. 2011;42:2240–2245. 5. Pilz S, Dobnig H, Fischer JE, Wellnitz B, Seelhorst U, Boehm BO, et al. Low vitamin D levels predict stroke in patients referred to coronary angiography. Stroke. 2008;39:2611–2613.
(Stroke. 2014;45:e46.) © 2014 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org
DOI: 10.1161/STROKEAHA.113.004276
Downloaded from http://stroke.ahajournals.org/ at UNIV e46 OF ULSTER AT COLERAINE on March 15, 2015
Letter by Tsuda Regarding Article, ''Serum Alkaline Phosphatase and Phosphate in Cerebral Atherosclerosis and Functional Outcomes After Cerebral Infarction'' Kazushi Tsuda Stroke. 2014;45:e46; originally published online January 21, 2014; doi: 10.1161/STROKEAHA.113.004276 Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2014 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/45/3/e46
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Stroke can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Stroke is online at: http://stroke.ahajournals.org//subscriptions/
Downloaded from http://stroke.ahajournals.org/ at UNIV OF ULSTER AT COLERAINE on March 15, 2015
