{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:43:50Z","timestamp":1791337430449,"version":"4.3.1"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Trimethylamine N-oxide (TMAO) has been recognized as a risk factor for cardiovascular disease. However, the role of TMAO in ischemic stroke remains unclear. As we know, ischemic stroke is a heterogeneous disease with variable pathogenesis. Hence, we aimed to investigate the association between TMAO and stroke recurrence according to etiology subtypes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A total of 10\u2009756 ischemic stroke\/transient ischemic attack patients from the Third China National Stroke Registry were enrolled, and 1-year follow-up data for stroke recurrence were analyzed. TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria was used to classify the etiology subtypes. Plasma TMAO levels were quantified by liquid chromatography\u2013mass spectrometry. The association between TMAO and stroke outcomes was analyzed using Cox regression models. We also conducted a meta-analysis on the association of TMAO levels and stroke risk.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Elevated TMAO level was independently associated with the risk of stroke recurrence (Q4 versus Q1: adjusted hazard ratio, 1.37 [95% CI, 1.15\u20131.64]) in multivariate Cox regression model. After stratification by TOAST subtypes, there was a significant association between TMAO and stroke recurrence in small artery occlusion subtype (adjusted hazard ratio, 1.43 [95% CI, 1.03\u20132.00]) but not in the others subtype (large-artery atherosclerosis, 1.19 [0.95\u20131.48]; cardioembolism, 1.54 [0.95\u20132.48]; others, 1.19 [0.98\u20131.44]). The meta-analysis reported on stroke recurrence for the highest versus lowest TMAO levels with a pooled hazard ratio of 1.66 (95% CI, 0.91\u20133.01) and similarly found an increased risk of stroke recurrence.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Elevated TMAO level is associated with increased risk of stroke recurrence in patients with small artery occlusion subtype, but this association seems to be attenuated in large-artery atherosclerosis, cardioembolism, and others subtypes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.120.031443","type":"journal-article","created":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T10:00:15Z","timestamp":1637316015000},"page":"1207-1215","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["Trimethylamine N-Oxide and Stroke Recurrence Depends on Ischemic Stroke Subtypes"],"prefix":"10.1161","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8320-218X","authenticated-orcid":true,"given":"Jie","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"Advanced Innovation Center for Human Brain Protection (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3230-9075","authenticated-orcid":true,"given":"Aichun","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"Advanced Innovation Center for Human Brain Protection (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Henan, China (B.S.)."}],"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, Health Science Center, Peking University, Beijing, China (M.Z., J. Xue, L.Z.)."},{"name":"Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (M.Z., J. Xue, L.Z.)."},{"name":"Key Laboratory of Molecular Cardiovascular Receptors Research, Beijing, China (M.Z., J. Xue, L.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"Advanced Innovation Center for Human Brain Protection (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.)."},{"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, Health Science Center, Peking University, Beijing, China (M.Z., J. Xue, L.Z.)."},{"name":"Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (M.Z., J. Xue, L.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4351-2877","authenticated-orcid":true,"given":"Anxin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"Advanced Innovation Center for Human Brain Protection (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3144-9463","authenticated-orcid":true,"given":"Liye","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"Advanced Innovation Center for Human Brain Protection (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9822-5758","authenticated-orcid":true,"given":"Jing","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"Advanced Innovation Center for Human Brain Protection (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Tiantan Hospital (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"Advanced Innovation Center for Human Brain Protection (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (J. Xu, A.C., J. 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Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"Advanced Innovation Center for Human Brain Protection (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.), Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (J. Xu, A.C., J. Xue, A.W., L.D., J.J., X.M., H.L., L.Z., Y.W.)."},{"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, Health Science Center, Peking University, Beijing, China (M.Z., J. Xue, L.Z.)."},{"name":"Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (M.Z., J. 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