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Gut microbiota‐derived trimethylamine N ‐oxide is associated with poor prognosis in patients with heart failure
Author(s) -
Li Wensheng,
Huang Anqing,
Zhu Hailan,
Liu Xinyue,
Huang Xiaohui,
Huang Yan,
Cai Xiaoyan,
Lu Jianhua,
Huang Yuli
Publication year - 2020
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.50781
Subject(s) - trimethylamine n oxide , hazard ratio , medicine , heart failure , confidence interval , renal function , prospective cohort study , cardiology , trimethylamine , chemistry , biochemistry
Objective Gut microbiota‐produced trimethylamine N ‐oxide ( TMAO ) is a risk factor for cardiovascular events. However, conflicting findings regarding the link between plasma TMAO level and prognosis for patients with heart failure have been reported. We examined the association of plasma TMAO concentration with risk of major adverse cardiac events ( MACE s) and all‐cause mortality in patients with heart failure. Study design Meta‐analysis of prospective clinical studies. Data sources We searched electronic databases (PubMed, EMBASE ) for published prospective studies examining associations between plasma TMAO level and MACE s and all‐cause mortality in adults with heart failure. Data synthesis Hazard ratios ( HR s) with 95% confidence intervals for associations between TMAO level and outcomes were estimated in random effects models. In seven eligible studies including a total of 6879 patients (median follow‐up, 5.0 years) and adjusted for multiple risk factors, higher plasma TMAO level was associated with greater risks of MACE s ( TMAO tertile 3 v tertile 1: HR , 1.68; 95% CI , 1.44–1.96; per SD increment: HR , 1.26; 95% CI , 1.18–1.36) and of all‐cause mortality ( TMAO tertile 3 v tertile 1: HR , 1.67; 95% CI , 1.17–2.38; per SD increment: HR , 1.26; 95% CI , 1.07–1.48). Higher TMAO level was also associated with greater risk of MACE s after adjusting for estimated glomerular filtration rate ( eGFR ; six studies included); however, the heterogeneity of studies in which risk was adjusted for eGFR was significant ( I 2 = 76%). Conclusions Elevated plasma TMAO level in patients with heart failure is associated with poorer prognoses. This association is only partially mediated by renal dysfunction.