Physicians' Academy for Cardiovascular Education

High levels of gut microbiome-generated TMAO associated with CV events and mortality

Gut microbe-generated metabolite trimethylamine-N-oxide as cardiovascular risk biomarker: a systematic review and dose-response meta-analysis

Literature - Schiattarella GG, Sannino A, Toscano E et al. - Eur Heart J ehx342. DOI: Published: 11 July 2017

Main results


This analysis in a large population shows that high-circulating concentrations of TMAO were associated with higher risk of all-cause mortality and MACCE. A dose-dependent, direct association was observed, and the observed association was consistent across subgroups and all study populations. The shape of the dose-response association requires further characterization.

Surprisingly, observations were consistent for patients with or without CKD, although high circulating TMAO levels have been described in CKD. Nor did geographical localization of populations affect the primary outcome, although dietary patterns may vary, although most studies were conducted in the USA and Europe.


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