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

Obesity exacerbates acute ischemic stroke (AIS) outcomes through metabolic dysfunction and chronic inflammation. Although Panax notoginseng saponins (PNS) have demonstrated efficacy in the treatment of AIS in the large-scale PANDA trial (N = 3072; 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. 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. Among 2779 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: 1.70–3.28) 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). 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.