{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:17:13Z","timestamp":1790198233795,"version":"4.1.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,10,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Trimethylamine N\u2010oxide (TMAO) contributes to cardiovascular disease through its prothrombotic, proatherothrombotic, and proinflammatory effects. We aimed to evaluate whether residual risk of recurrent stroke of TMAO and its precursor choline remain among patients who received dual\u2010antiplatelet therapy and intensive lipid\u2010lowering therapy and with a low inflammation level (high\u2010sensitivity C\u2010reactive protein &lt;2\u2009mg\/L on admission).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with ischemic stroke or transient ischemic attack were enrolled from the CNSR\u2010III (Third China National Stroke Registry) in China. Plasma TMAO and choline concentrations at baseline were measured in 9793 participants using liquid chromatography\u2013mass spectrometry. The primary outcome was a new stroke within 1\u2009year. Multivariable\u2010adjusted hazard ratios were calculated using Cox regression models to investigate the associations of TMAO and choline with stroke recurrence. Among all patients, elevated TMAO and choline levels were associated with an increased risk of recurrent stroke (adjusted hazard ratios, 1.28 [95% CI, 1.12\u20131.45]; and 1.50 [95% CI, 1.32\u20131.71], respectively). Moreover, elevated TMAO and choline levels were associated with an increased risk of recurrent stroke among patients who received dual\u2010antiplatelet therapy (1.65 [95% CI, 1.28\u20132.13]; and 1.70 [95% CI, 1.32\u20132.19], respectively), intensive lipid\u2010lowering therapy (1.49 [95% CI, 1.15\u20131.94]; and 1.49 [95% CI, 1.15\u20131.92], respectively), with high\u2010sensitivity C\u2010reactive protein &lt;2\u2009mg\/L (1.39 [95% CI, 1.14\u20131.69]; and 1.88 [95% CI, 1.53\u20132.30], respectively), and concurrently received dual\u2010antiplatelet therapy, intensive lipid\u2010lowering therapy and with high\u2010sensitivity C\u2010reactive protein &lt;2\u2009mg\/L (3.57 [95% CI, 1.73\u20137.38]; and 2.19 [95% CI, 1.16\u20134.16], respectively).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">TMAO and choline were risk factors for recurrent stroke independent of dual\u2010antiplatelet therapy, intensive lipid\u2010lowering therapy at discharge, and low inflammation on admission.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.027265","type":"journal-article","created":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T11:58:02Z","timestamp":1664884682000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Residual Risk of Trimethylamine\u2010N\u2010Oxide and Choline for Stroke Recurrence in Patients With Intensive Secondary Therapy"],"prefix":"10.1161","volume":"11","author":[{"given":"Jing","family":"Xue","sequence":"first","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8320-218X","authenticated-orcid":false,"given":"Jie","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Zhao","sequence":"additional","affiliation":[{"name":"The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center Peking University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7221-5444","authenticated-orcid":false,"given":"Aoming","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3230-9075","authenticated-orcid":false,"given":"Aichun","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinxi","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4473-6936","authenticated-orcid":false,"given":"Lemin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"},{"name":"The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center Peking University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9976-2341","authenticated-orcid":false,"given":"Yongjun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases Capital Medical University Beijing China"},{"name":"Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China"},{"name":"Center for Excellence in Brain Science and Intelligence Technology, Chinese 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