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BackgroundAssessment of the risks of stroke and then initiation of primary prevention are crucial to reducing the incidence rate of stroke. Trimethylamine-N-oxide (TMAO) is a recently discovered intestinal microbial metabolite, whose relationships with the risks of stroke have been rarely reported.ObjectiveTo explore the correlation between serum TMAO levels and the risks of acute ischemic stroke (AIS) .MethodsWith the supporting by the project of the National Health Commission (stroke high risk population screening and intervention) , five hundred cases were randomly selected from the stroke screening population in the New Urban Community of Hohhot city of Inner Mongolia from October to December 2020. Finally, 399 cases were included according to the set of standard, and then the 399 cases were divided into normal control group (n=121) , moderate AIS risk group (n=141) , and high AIS risk group (n=137) in accordance with the screening results (score of stroke risk rated using a scoring card) . Demographic and laboratory indices (including serum TMAO detected using ELISA) of all cases were collected. Pearson correlation test and Spearman rank correlation test were conducted to measure the correlation of TMAO with AIS risks. Multinomial and ordinal Logistic regressions were used to explore the influencing factors of AIS risks. ROC analysis was used to estimate the predictive value of TMAO for AIS risk.ResultsCompared with the control group, the serum TMAO level in high-risk group was increased significantly (P