Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.
Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Front Endocrinol (Lausanne). 2024 Jul 18;15:1360861. doi: 10.3389/fendo.2024.1360861. eCollection 2024.
Gut microbiota has significant impact on the cardio-metabolism and inflammation, and is implicated in the pathogenesis and progression of atherosclerosis. However, the long-term prospective association between trimethylamine N-oxide (TMAO) level and major adverse clinical events (MACEs) in patients with coronary artery disease (CAD) with or without diabetes mellitus (DM) habitus remains to be investigated.
This prospective, single-center cohort study enrolled 2090 hospitalized CAD patients confirmed by angiography at Beijing Hospital from 2017-2020. TMAO levels were performed using liquid chromatography-tandem mass spectrometry. The composite outcome of MACEs was identified by clinic visits or interviews annually. Multivariate Cox regression analysis, Kaplan-Meier analysis, and restricted cubic splines were mainly used to explore the relationship between TMAO levels and MACEs based on diabetes mellitus (DM) habitus.
During the median follow-up period of 54 (41, 68) months, 266 (12.7%) developed MACEs. Higher TMAO levels, using the tertile cut-off value of 318.28 ng/mL, were significantly found to be positive dose-independent for developing MACEs, especially in patients with DM (HR 1.744, 95%CI 1.084-2.808, = 0.022).
Higher levels of TMAO are significantly associated with long-term MACEs among CAD patients with DM. The combination of TMAO in patients with CAD and DM is beneficial for risk stratification and prognosis.
肠道微生物群对心脏代谢和炎症有重要影响，并与动脉粥样硬化的发病机制和进展有关。然而，三甲胺 N-氧化物（TMAO）水平与合并或不合并糖尿病（DM）体态的冠心病（CAD）患者主要不良临床事件（MACEs）之间的长期前瞻性关联仍有待研究。
本前瞻性、单中心队列研究纳入了 2017 年至 2020 年在北京医院经血管造影证实的 2090 例住院 CAD 患者。采用液相色谱-串联质谱法测定 TMAO 水平。通过每年的临床就诊或访谈确定 MACE 的复合结局。主要采用多变量 Cox 回归分析、Kaplan-Meier 分析和限制立方样条来探讨 TMAO 水平与基于糖尿病（DM）体态的 MACEs 之间的关系。
在中位数为 54（41，68）个月的随访期间，266 例（12.7%）发生了 MACEs。使用三分位数截断值 318.28ng/ml，发现较高的 TMAO 水平与发生 MACEs呈正相关，且与剂量无关，尤其是在合并 DM 的患者中（HR 1.744，95%CI 1.084-2.808， = 0.022）。
TMAO 水平较高与合并 DM 的 CAD 患者的长期 MACEs 显著相关。TMAO 与 CAD 和 DM 患者联合应用有助于风险分层和预后判断。
