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Elevated plasma TMAO levels associated with all-cause mortality in CAD patients in South China
Hao Zhang1, Yuan-Yuan Peng1, Xi-Ya Lu1,2
1Department of Geriatrics, National Clinical Research Center for Geriatric Diseases (Xiangya Hospital of Central South University), Central South University, Changsha, 410008, P.R. China.
Background:
Coronary artery disease (CAD) is a prevalent cardiovascular condition worldwide. Trimethylamine N-oxide (TMAO), a metabolite produced by gut microbiota, plays a crucial role in the pathogenesis and progression of CAD. However, the association between plasma TMAO and all‑cause mortality in Chinese CAD patients remains to be fully explored.
Methods:
In this observational cohort study, 389 hospitalized CAD patients, confirmed via coronary angiography at Xiangya Hospital in 2022, were enrolled. Plasma TMAO levels were measured using liquid chromatography-tandem mass spectrometry. All-cause mortality events were identified through telephone interviews, hospital outpatient visits, and official hospital records, conducted semi-annually. Kaplan-Meier analysis and Cox regression analysis were employed to investigate the relationship between TMAO levels and all-cause mortality.
Results:
Among 364 CAD patients who completed the median follow-up period of 39 months (IQR: 37-42 months), 40 patients (11.0%) experienced all-cause mortality. Patients with elevated TMAO levels, based on the optimal cutoff value of 317.62 ng/mL, had a significantly higher mortality rate compared to those with lower levels (P < 0.0001). After adjusting for conventional risk factors, including diabetes, elevated TMAO levels showed a significant association of all-cause mortality (hazard ratio [HR] 2.657; 95% CI: 1.389 to 5.084; P = 0.003).
Conclusions:
Elevated plasma TMAO levels are significantly associated with increased all-cause mortality over a median follow-up of 39 months in CAD patients from South China.
