Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

Journal：Stroke

Publication type: Original Article

IF(IF): 7.914

PMID: 34794334 Link To Pubmed Full text Download

Gut flora and its metabolites are increasingly recognized to play an important role in various diseases, including cardiovascular disease (CVD) and stroke. Trimethylamine-n-oxide (TMAO), a gut-derived metabolite, is the oxygenated product of trimethylamine, which is a waste product derived from food ingredients such as choline, l-carnitine and betaine. Numerous previous studies have confirmed that TMAO is closely related to the increased risk of cardiovascular disease. However, the evidence about the role of TMAO in ischemic stroke is limited and debated. To date, the relationship between TMAO levels and stroke outcomes with different etiologies has not yet been examined. Previous studies have shown that TMAO increases the risk of CVD primarily through its atherogenic effect, including increasing the accumulation of cholesterol in macrophages and the formation of foam cells, proinflammatory changes in arterial walls, and platelet hyperresponsiveness. In addition, increasing evidence also shows that TMAO is highly associated with diabetes, hypertension and even atrial fibrillation(AF).A rational hypothesis is that plasma TMAO levels may have different effects on stroke outcomes in patients with different TOAST subtypes. Hence, we sought to explore the relationship between TMAO and stroke outcomes in patients with different TOAST subtypes from the Third China National Stroke Registry (CNSR-III).

The associations of TMAO with outcomes were examined using Cox regression model. Kaplan–Meier product limit method was used to generate survival plots, and the significance of differences between groups was tested by the log-rank test.