College of Medicine, Nankai University, Tianjin, China.
Department of Radiotherapy, the First Hospital of Tsinghua University, Beijing Huaxin Hospital, Beijing, China.
Ann Palliat Med. 2021 Nov;10(11):11512-11523. doi: 10.21037/apm-21-2763.
The gut microbiota-dependent metabolite trimethylamine N-oxide (TMAO) has recently been recognized as one of the novel marker for adverse cardiovascular events and risk of death. However, data on the relationship between TMAO and atrial fibrillation (AF) is limited. The current study was performed to quantify and evaluate the relationship between circulating TMAO levels and AF occurrence.
The electronic databases PubMed, Cochrane Library, and Embase were systematically searched to March 20, 2021. Research studies were considered that recorded or analyzed the prevalence of AF in individuals in specific populations as well as their circulating TMAO levels. A meta-analysis of two-class variables was used to obtain pooled effects. A dose-response meta-analysis was used to investigate the dose-response relationship between TMAO levels and the risk of AF.
Six studies with a total of 8,837 individuals and 1,668 AF cases were included in the present meta-analysis. Compared with a lower circulating TMAO level, a higher TMAO level was associated with a higher prevalence of AF [odds ratio (OR): 1.40; 95% confidence interval (CI): 1.23, 1.59; I2=19.8%]. The dose-response analysis revealed the risk of AF increased by 6% per 1-µmol/L increment (OR: 1.06; 95% CI: 1.00, 1.11), 32% per 5-µmol/L increment (OR: 1.32; 95% CI: 1.03, 1.70), and 73% per 10-µmol/L increment (OR: 1.73; 95% CI: 1.05, 2.86) of the circulating TMAO level.
This is the first systematic literature review and meta-analysis to demonstrate a significant dose-dependent relationship between increased AF risk and circulating TMAO levels.
肠道微生物群依赖的代谢产物三甲胺 N-氧化物（TMAO）最近被认为是不良心血管事件和死亡风险的新型标志物之一。然而，关于 TMAO 与心房颤动（AF）的关系的数据有限。本研究旨在定量评估循环 TMAO 水平与 AF 发生之间的关系。
系统检索了电子数据库 PubMed、Cochrane 图书馆和 Embase，检索时间截至 2021 年 3 月 20 日。研究记录或分析了特定人群中个体的 AF 患病率及其循环 TMAO 水平。使用两分类变量的荟萃分析来获得汇总效应。进行剂量-反应荟萃分析以研究 TMAO 水平与 AF 风险之间的剂量-反应关系。
本荟萃分析纳入了 6 项研究，共 8837 人，1668 例 AF 病例。与较低的循环 TMAO 水平相比，较高的 TMAO 水平与更高的 AF 患病率相关[比值比（OR）：1.40；95%置信区间（CI）：1.23，1.59；I²=19.8%]。剂量-反应分析显示，AF 风险每增加 1µmol/L，风险增加 6%（OR：1.06；95%CI：1.00，1.11），每增加 5µmol/L，风险增加 32%（OR：1.32；95%CI：1.03，1.70），每增加 10µmol/L，风险增加 73%（OR：1.73；95%CI：1.05，2.86）。
这是首次系统的文献综述和荟萃分析，表明 AF 风险增加与循环 TMAO 水平之间存在显著的剂量依赖性关系。
