Author + information
Recent animal studies show a mechanistic link between intestinal microbial metabolism of dietary phosphatidylcholine and coronary artery disease (CAD) pathogenesis. Levels of the pro-atherosclerotic metabolite trimethylamine-N-oxide, TMAO, are elevated in patients with diabetes mellitus (DM), but their prognostic value remains unclear.
We examined the relationship between fasting plasma TMAO and incident major adverse cardiac events (MACE=death, myocardial infarction, stroke) over 3-year follow-up in 4,007 stable subjects undergoing elective coronary angiography.
In our study cohort, median TMAO levels were higher in DM (4.4[IQR 2.8-7.7]) versus non-DM (3.5[2.3-5.6], p<0.001). Higher plasma TMAO level was associated with a 3-fold increased risk of MACE in DM and a 2.1-fold increased risk of MACE in non-DM. Following adjustments for traditional risk factors and hsCRP, elevated TMAO levels remained predictive of MACE risk in both DM (Quartiles 4 vs. 1: Hazard ratio [HR]2.53 [95%CI 1.66-3.84], p<0.001) and non-DM (HR 1.61 [95%CI 1.15-2.26], p<0.001). There was only modest correlation between TMAO and HbA1c(r=0.11; p<0.01).
High plasma TMAO levels, a pro-atherogenic compound formed by gut flora dependent metabolism of the choline group of phosphatidylcholine, portend stronger incident risk of MACE in both diabetics and non-diabetics alike, with modest relationship to glycemic control.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Prevention: Diabetes and Risk
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1185-7
- 2013 American College of Cardiology Foundation