Trimethylamine N ‐Oxide and Mortality Risk in Patients With Peripheral Artery Disease
Open accessAbstract
Background: Production of the proatherogenic metabolite, trimethylamine N ‐oxide ( TMAO ), from dietary nutrients by intestinal microbiota enhances atherosclerosis development in animal models and is associated with atherosclerotic coronary artery disease in humans. The utility of studying plasma levels of TMAO to risk stratify in patients with peripheral artery disease ( PAD ) has not been reported. Methods and Results: We examined the relationship between fasting plasma TMAO and all‐cause mortality (5‐year), stratified by subtypes of PAD and presence of coronary artery disease in 935 patients with PAD who underwent elective angiography for cardiac evaluation at a tertiary care hospital. Median plasma TMAO was 4.8 μmol/L (interquartile range, 2.9–8.0 μmol/L). Elevated TMAO levels were associated with 2.7‐fold increased mortality risk (fourth versus first quartiles, hazard ratio 2.86, 95% CI 1.82–3.97, P <0.001). Following adjustments for traditional risk factors, inflammatory biomarkers, and history of coronary artery disease, the highest TMAO quartile remained predictive of 5‐year mortality (adjusted hazard ratio 2.06, 95% CI 1.36–3.11, P <0.001). Similar prognostic value for elevated TMAO was seen for subjects with carotid artery, non–carotid artery, or lower extremity PAD . TMAO provided incremental prognostic value for all‐cause mortality (net reclassification index, 40.22%; P <0.001) and improvement in area under receiver operator characteristic curve (65.7% versus 69.4%; P =0.013). Conclusions: TMAO , a pro‐atherogenic metabolite formed by gut microbes, predicts long‐term adverse event risk and incremental prognostic value in patients with PAD . These findings point to the potential for TMAO to help improve selection of high‐risk PAD patients with or without significant coronary artery disease, who likely need more aggressive and specific dietary and pharmacologic therapy.
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Circulating levels of trimethylamine N-oxide associate with cardiovascular disease and predict outcomes in multiple cardiovascular disease phenotypes, including peripheral artery disease, coronary artery disease, acute coronary syndrome, and heart failure.
“Circulating levels of TMAO have been shown to associate with CVD and predict outcomes in the presence of multiple CVD phenotypes, including peripheral artery disease (PAD)96, coronary artery disease (CAD)97, acute coronary syndrome (ACS)97–99, and heart failure100–104.”
From Gut microbiota and cardiovascular disease. (2020) · cites this paper as [96]
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- Authors
- Senthong, V., Wang, Z., Fan, Y., Wu, Y., Hazen, S. L., & Tang, W. H. W.
- Affiliations
- Cleveland Clinic (US)
- Cleveland State University (US)
- Corresponding author
- Tang, W. H. Wilson
- Venue
- Journal of the American Heart Association
- Published
- 2016-10-03
- Volume
- 5
- Issue
- 10
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC5121520
- OpenAlex
- W2536190224
- Cited by
- 175
- References
- 27
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 9 · 2023: 17 · 2022: 26 · 2021: 21 · 2020: 25 · 2019: 15 · 2018: 21 · 2017: 16
- FWCI
- 19.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- EngagedScholarship @ Cleveland State University (Cleveland State University) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000439)
- National Heart, Lung, and Blood Institute (R01HL103931, R01HL126827, P20HL113452, P01HL076491, P01HL098055, R01HL130819, R01HL103866)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106000)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- trimethylamine N-oxide, peripheral arterial disease, all-cause mortality, prognostic factors, gut microbiota, atherosclerosis, coronary artery disease, carotid artery disease, lower extremity arterial disease, risk stratification, net reclassification improvement
- MeSH terms
- Gastrointestinal Microbiome, Computed Tomography Angiography, Aged, Cause of Death, Coronary Artery Disease, Female, Humans, Male, Methylamines, Middle Aged, Mortality, Prognosis, Risk, Ultrasonography, United States, Cohort Studies, Proportional Hazards Models, Carotid Stenosis, Coronary Angiography, Risk Assessment, Magnetic Resonance Angiography, Lower Extremity, Kaplan-Meier Estimate, Peripheral Arterial Disease
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