Abstract WP263: Associations of Equol-Producing Status With Cardioembolic Stroke in Japanese Patients With Stroke

Abstract

Introduction: Equol, a metabolite of a soy isoflavone daidzein transformed by the gut microbiota, is associated with the amelioration of cardiovascular diseases and cognitive impairment. Approximately 50% of Asians and 30% of Westerners may be equol producers depending on the presence of equol-producing gut microbiota. It is still unknown whether equol-producing status is associated with development of stroke and its prognosis. Methods: In this single-center, retrospective study, we investigated the serum concentration of equol in 200 patients with stroke hospitalized in the National Cerebral and Cardiovascular Center (NCVC) from September 2019 to October 2021, and 103 healthy subjects registered in the Suita Study, a population-based cohort study at NCVC from November 2016 to September 2018. The concentration of equol was measured using liquid chromatography-mass spectrometry. Results: Eighty-five patients with stroke (43.5%) and 50 healthy subjects (48.5%) were equol producers ( p =0.32). However, patients with cardioembolic stroke (CES) had a significantly lower frequency of the equol producers (28.9%) compared to healthy subjects ( p =0.04), as well as patients with other stroke subtypes (48.0%) ( p =0.04). The prevalence of atrial fibrillation was significantly lower in equol producers than that in non-producers (26.3% vs. 47.3%, p =0.04) among patients with ischemic stroke. Additionally, equol-producing status was an independent predictor for a favorable outcome (modified Rankin scale 0-2) at discharge for ischemic stroke in a multivariable logistic regression analysis (odds ratio 2.75, 95% confidential interval 1.05-7.27, p =0.04). Discussion: CES, atrial fibrillation, and clinical outcome may be influenced by equol-producing status. These findings could provide new insights into the racial difference in the prevalence of CES between Asians and Westerners.