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Relationship between Level of Trimethylamine Oxide and the Risk of Recurrent Cardiovascular Events in Patients with Acute Myocardial Infarction
Background: This study investigated the value of trimethylamine oxide (TMAO) and its precursors in secondary prevention for patients with acute myocardial infarction (AMI).
Methods: We retrospectively enrolled patients diagnosed with AMI. The associations of TMAO and its precursors with endpoint events were estimated by Cox proportional hazards models.
Results: During a median follow-up of 6.4 years, 319 (32.0%) major adverse cardiovascular events (MACE) occurred in the 996 patients enrolled. After adjusting for traditional risk factors, the risk of MACE, cardiac death, and recurrent MI increased by 28% (HR 1.28, 95% CI 1.10–1.49), 44% (HR 1.44, 95% CI 1.12–1.84), and 27% (HR 1.27, 95% CI 1.04–1.55), respectively, per 1 increment in ln-transformed TMAO. After adjustment for the levels of its precursors, TMAO and MACE relationship still significant. Choline was associated with MACE, all-cause mortality, cardiac death, and risk of recurrent MI after adjusting for the levels of the remaining metabolites in addition to traditional risk factors. The overall ability to predict all-cause mortality was better for the choline model than for the TMAO model (continuous NRI 0.185, P=0.007; IDI 0.030, P=0.020). Mediation effect analysis showed that the mediating effect of TMAO on choline and the risk of all-cause mortality was 11.39% (95% CI 0.0209–0.2200, P=0.016) and the existence of a choline activity pathway that was independent of the TMAO pathway.
Conclusions: TMAO and choline were associated with an increased risk of MACE in patients with AMI, and choline had better predictive power.
Ji, Wenjun and Zhang, Bin and Liu, Jiahui and Li, Kaiyin and Jia, Jia and Fan, Fangfang and Jiang, Jie and Wang, Xingang and Zhang, Yan, Relationship between Level of Trimethylamine Oxide and the Risk of Recurrent Cardiovascular Events in Patients with Acute Myocardial Infarction. Available at SSRN: https://ssrn.com/abstract=5191104 or http://dx.doi.org/10.2139/ssrn.5191104
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