Efficacy of Panax notoginseng saponins on functional outcome in obese patients with acute ischemic stroke

Background: saponins (PNS) have demonstrated efficacy in the treatment of AIS in the large-scale PANDA trial (N = 3,072; ChiCTR1800016363), their benefits in patients with obesity specifically, remain unclear. This study aimed to evaluate the effect of PNS on functional outcomes in patients with obesity. Methods: This analysis utilized individual patient data from the PANDA trial. Participants were stratified by body mass index (BMI), waist circumference (WC), and a combination of both metrics. The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days. Adjusted odds ratios (aORs) were calculated using multivariable logistic regression. Results: Among 2,779 patients (mean age 60.7 ± 9.3 years), 58.3% were classified as overweight or obese by BMI, and 65% met criteria for abdominal obesity based on WC. PNS significantly improved rates of functional independence at 90 days across overweight (aOR = 2.05; 95% CI: 1.39-3.06), obesity (aOR = 2.18; 95% CI: 1.11-4.41), and abdominal obesity (aOR = 2.37; 95% CI: 1.73-3.28) subgroups. Consistent benefits were observed in patients with abdominal obesity irrespective of BMI category: lower BMI (aOR = 2.45; 95% CI: 1.34-4.61) and higher BMI (aOR = 2.40; 95% CI: 1.64-3.54). Conclusions: These results indicate that PNS may improve 90-day functional outcomes in patients with AIS and obesity, including those with abdominal obesity, warranting further prospective validation.