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Abstract Details

Altered Gut Microbiome and the Risk of Ischemic Stroke - an Umbrella Meta-Analysis
General Neurology
P9 - Poster Session 9 (11:45 AM-12:45 PM)
2-011

To comprehensively analyze the association between gut-microbiota-produced trimethylamine-N-oxide (TMAO) and the risk of ischemic stroke.
Globally, stroke is the second leading cause of death and the third leading cause of death and disability combined. Gut bacteria dynamically communicate with the host along the bidirectional 'microbiota-gut-brain-axis'(MGBA) to regulate the immune, metabolic, and nervous systems.  Gut microbiota dysbiosis can alter MGBA, which has been linked to adverse health outcomes. Gut bacteria metabolize certain nutrients to trimethylamine(TMA), which the liver converts to TMAO. An altered MGBA can manifest as increased plasma TMAO levels. Several studies suggest a positive association between elevated TMAO levels and an increased risk of disease including ischemic stroke. We sought to determine if TMAO concentration reliably predicts stroke risk conclusively.

We conducted an umbrella meta-analysis of meta-analyses from observational studies published in the last 10 years using PRISMA guidelines in PubMed. Using RevMan 5.4, we performed an inverse variance random effects model to calculate log (odds ratio[OR]) and converted it to pooled OR and 95% confidence interval(CI) to obtain a forest plot keeping alpha criteria 0.05. Heterogeneity and risk of bias assessment were assessed.
An umbrella meta-analysis of the included studies (n=36,958) examining the association between TMAO and stroke risk revealed a statistically significant association. Higher plasma TMAO was associated with 76% elevated risk of ischemic stroke [pooled-OR: 1.76 (95%CI 1.14-2.13, p=0.01) in comparison to those with a normal level. There was no significant heterogeneity (I2=0%, p=0.84) between the studies. There was a moderate risk of bias for overall studies using Newcastle-Ottawa Scale.
Our study confirms a strong association between elevated TMAO, a gut microbe-dependent metabolite, and increased stroke risk. This finding positions TMAO as a potential biomarker for stroke risk stratification and highlights the need to investigate targeted interventions aimed at modulating gut microbiota to lessen cerebrovascular risk.
Authors/Disclosures
Kogul Arumaithurai, MD (Mayo Clinic)
PRESENTER 		Dr. Arumaithurai has nothing to disclose.
Gaurav Sudhir, MBBS Dr. Sudhir has nothing to disclose.
Devansh B. Gupta, MBBS Dr. Gupta has nothing to disclose.
Aishah Khan, MBBS Dr. Khan has nothing to disclose.
Sarayu Devabhaktuni, MBBS Ms. Devabhaktuni has nothing to disclose.
Sindu Mukesh, MBBS Dr. Mukesh has nothing to disclose.
Aakash Baskar, MBBS (K.A.P. Viswanatham Govt Medical College) Mr. Baskar has nothing to disclose.
Arpita Bhriguvanshi No disclosure on file
Rohan Arora, MD The institution of Dr. Arora has received research support from Bayer.
Urvish K. Patel (Icahn School of Medicine At Mount Sinai/ Creighton University) Mr. Patel has nothing to disclose.