Heart failure & cardiomyopathies
Trimethylamine N -Oxide and Related Gut Microbe-Derived Metabolites and Incident Heart Failure Development in Community-Based Populations
Authors' conclusion
In this pooled analysis of 2 well-phenotyped, diverse, community-based cohorts, circulating concentrations of gut microbe-derived metabolites such as trimethylamine N-oxide, choline, and crotonobetaine were independently associated with a higher risk of developing HF.
Study context
- Population
- Community-based adults from the Cardiovascular Health Study and the Multi-Ethnic Study of Atherosclerosis2,102 heart failure (HF) cases
- Participants
- 11,768 adults
- Comparison
- Higher vs lower circulating concentrations of TMAO and related gut microbe-derived metabolites
- Outcome
- Incident HF
- Follow-up
- Median 15.9 years
Methodological detailsCox proportional hazards models, adjusted for CVD risk factors, serial metabolite measures
- Cox proportional hazards models
- Adjusted for CVD risk factors
- Serial metabolite measures
Pooled result
As reported in the abstract
Incident HF, per higher metabolite concentration (adjusted for traditional risk factors)
Hazard ratio (95% CI)P value
Trimethylamine N-oxide
1.15(1.09–1.20)
P < 0.001Choline
1.44(1.26–1.64)
P < 0.001Crotonobetaine
1.24(1.16–1.32)
P < 0.001Per higher metabolite concentration, as printed
- Betaine and carnitine nominally associated with higher HF incidence
- P < 0.05
Further pooled results
Incident HF, further adjusted for renal function
- Trimethylamine N-oxide: did not reach Bonferroni-corrected significance
- P = 0.01
- Choline: did not reach Bonferroni-corrected significance
- 0.049
- Crotonobetaine: did not reach Bonferroni-corrected significance
- 0.006
- Renal function as potential confounder or mediator
HF subtypes by LVEF (exploratory)
- Results similar for HF subtypes based on LVEF
- Exploratory analysis
By race (exploratory)
- Associations generally stronger among Black and Hispanic/Latino vs White adults; no interactions for any metabolite with race
- Exploratory analysis
Original publication
Trimethylamine N -Oxide and Related Gut Microbe-Derived Metabolites and Incident Heart Failure Development in Community-Based Populations. Circ Heart Fail. Published 9 August 2024. doi:10.
Summarised from the published abstract; every number is checked against it