Association of lignan metabolites with prevalent stroke and mortality in stroke patients: results from NHANES

This study explores the association between urinary lignan metabolites (enterolactone and enterodiol) and prevalent stroke (self-reported history of stroke), as well as the long-term likelihood of all-cause mortality (ACM) in patients with a history of stroke. This study employed a mixed-methods design integrating cross-sectional and retrospective cohort analyses, leveraging data from the National Health and Nutrition Examination Survey (NHANES) spanning the period 1999-2010. Eligible participants were those with complete data on urinary lignan metabolites (enterolactone and enterodiol), stroke status assessment, and long-term survival outcomes. Weighted logistic regression models were utilized to elucidate the association between enterolactone, enterodiol, and the likelihood of prevalent stroke, with subgroup analyses stratified by age and gender; effect sizes were quantified as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). The study included 9,752 participants, among whom 194 were dead patients. Follow-up was conducted through December 2019, with a total duration of 164.97 ± 0.87 months. The analysis revealed no statistical association between enterodiol and prevalent stroke or ACM in patients with a history of stroke. Using the first quartile of enterolactone as a reference, the fourth quartile group of enterolactone was significantly associated with a lower likelihood of prevalent stroke [OR: 0.64 (0.42-0.98)], particularly in males [OR: 0.43 (0.20-0.91)] and those under the age of 65 years [OR: 0.43 (0.19-0.97)]. Higher urinary enterolactone levels were associated with a lower likelihood of prevalent stroke and reduced ACM likelihood in patients with a history of stroke.