Physicians' Academy for Cardiovascular Education

TMAO, formed by gut microbiota, associates with incident MACE and mortality

Gut microbiota-dependent trimethylamine N-oxide in acute coronary syndromes: a prognostic marker for incident cardiovascular events beyond traditional risk factors

Literature - Li XS, Obeid S, Klingenberg R, et al. - Eur Heart J, 2017, Epub ahead of print


Recent studies emphasise the role of gut microbes in the development of atherosclerotic heart disease and adverse thrombotic events [1-5]. Trimethylamine N-oxide (TMAO) is a plasma metabolite that is formed by nutrient precursors abundant in a Western diet, such as choline, and gut microbiota [1]. TMAO levels have been shown to associate with cardiovascular risk [1-3, 5].

Its relationship with incident risk in individuals with acute coronary syndrome (ACS) has not been studied yet. Therefore, this study explored the relationship between systemic levels of TMAO and incident major adverse cardiovascular events (MACE) and mortality among individuals with ACS, using the single centre Cleveland cohort (n=530) and the multi-site Swiss ACS cohort (n=1683) that is part of the special program university medicine (SPUM). Cleveland patients presented in the emergency department with chest pain of suspected cardiac origin within 24hrs of onset, whereas Swiss patients include all patients who underwent coronary angiography for ACS.

Main results


TMAO levels were associated with short-term risk of MACE and long-term mortality in two independent ACS cohorts comprising sequential patients who presented with complaint of chest pain and suspected ACS. The relationship with risk of incident MACE was dose-dependent. Therefore, gut microbiota-dependent metabolite, TMAO, may serve as a clinically useful and potentially modifiable prognostic marker.


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Find this article online at Eur Heart J

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