Higher serum free fatty acid levels associated with worse 3-month prognosis after acute ischemic stroke

BACKGROUND: Free fatty acid (FFA) serves as an important link between metabolic risk factors and atherosclerotic vascular disease. In this post hoc analysis of the Intensive Statin and Antiplatelet Therapy for Acute High Risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial, we aimed to investigate whether serum FFA concentration was associated with prognosis of acute ischemic stroke. METHODS: Data was obtained from the INSPIRES trial, which was a randomized, double-blind, placebo-controlled, multicenter two-by-two factorial trial at 222 hospitals in China. Fasting venous blood samples were collected from all subjects within 24 hours after randomization. Enrolled patients were divided into 4 groups according to the FFA quartiles. RESULTS: A total of 5813 participants were included, with the median age of 65 years, and 35.9% were women. The median FFA level was 0.45 (interquartile range, 0.31-0.61) mmol/L. After adjusting for potential covariates, elevated FFA level was associated with higher risk of new stroke at 3 months (Q4 vs. Q1: HR 1.85, 95% CI 1.41 to 2.43) and poor functional outcome (Q3 vs. Q1: RR 1.66, 95% CI 1.19 to 2.32; Q4 vs. Q1: RR 1.73, 95% CI 1.37 to 2.16). FFA as a continuous variable was associated with a new stroke and poor functional outcome. Similar results were observed for the outcomes of composite vascular events, ischemic stroke and all-cause mortality. CONCLUSIONS: Elevated baseline serum FFA level was associated with an increased risk of new stroke, as well as composite vascular events, ischemic stroke, and poor functional outcome at 3-month follow-up in patients with acute ischemic stroke.