Microbiota-derived Trimethylamine N-oxide Predicts Cardiovascular Risk After STEMI

Area of Science:

• Cardiovascular Medicine
• Microbiome Research
• Metabolomics

Background:

• Trimethylamine N-oxide (TMAO), a gut microbiota metabolite, is linked to atherosclerosis and cardiovascular events.
• The dynamic changes and prognostic value of TMAO in ST-segment elevation myocardial infarction (STEMI) patients undergoing secondary prevention are not well understood.

Purpose of the Study:

• To investigate the sequential changes in plasma TMAO levels during secondary prevention therapy in STEMI patients.
• To assess the predictive value of TMAO levels in different phases (acute vs. chronic) for subsequent cardiovascular events.

Main Methods:

• Plasma TMAO levels were measured in 112 STEMI patients during the acute phase and 10 months post-STEMI.
• Patients were followed for a median of 5.4 years to record cardiovascular events.
• Statistical analysis, including Cox proportional hazards models, was used to evaluate TMAO's predictive capacity.

Main Results:

• Plasma TMAO levels significantly increased from the acute to the chronic phase post-STEMI (median: 5.63 to 6.76 μM, P=0.048).
• Higher chronic-phase TMAO levels independently predicted future cardiovascular events (aHR for 0.1 increase in log TMAO: 1.343, P=0.001).
• Acute-phase TMAO levels did not show significant predictive value for cardiovascular events.

Conclusions:

• TMAO levels show a significant increase in the chronic phase following STEMI, despite secondary prevention therapies.
• Chronic-phase TMAO levels are a robust independent predictor of long-term cardiovascular events in STEMI survivors.
• Monitoring chronic-phase TMAO may aid in risk stratification and management of STEMI patients.